LIFELINE (01-243) by Junep Ocampo

LifeLine PrehosPitaL emergency care

PREHOSPITAL EMERGENCY CARE PUBLISHER: Michael H. Deakin EDITOR: Nlkdsiusd Dskdgi TECHNICAL EDITORS: Junep Ocampo CONTRISBUTING EDITORS: Paul Violeta and Magnolia CONTRIBUTING WRITERS: Nkfig Kfgifgmdo BOOK DESIGNER: Danilo Hernando

Lifeline Prehospital Emergency Care, A Guidebook for Filipino Emergency Medical Technicians, is published by the Lifeline Emergency Medical Service (EMS) Academy as a textbook for its students and a ready guidebook for its graduates The contents of this book have been culled from various references, both foreign and local, and combined with insights acquired through years of experience by Lifeline EMS Academy teachers and Lifeline Rescue personnel. The procedures described in this book are based on the references clearly cited at the bottom of every chapter. The publisher and editors have taken care to make sure that these procedures reflect currently accepted clinical practice, yet caution should always be exercised as these procedures cannot be considered absolute recommendations. The information in this book are the most current available at the time of this publication. However, local, national and international guidelines concerning practices, including (without limitation) those related to infection control and universal precautions, may change rapidly. Readers are advised to check new regulations and take them into consideration as they may require changes in some procedures. It is the reader’s responsibility to familiarize himself or herself with the policies and procedures by international and local agencies as well as the institution or agency where the reader is employed.

Lifeline EMS Academy, the publisher, editors and contributors for this book disclaim any liability, loss or risk resulting directly or indirectly from the suggested procedures and theory, from any undetected errors or from the reader’s misunderstanding of the text. It is the reader’s responsibility to stay informed on any new changes or recommendations made by any agency as well as by his or her employing institution or agency. The situations depicted in the Lifeline in Action portion of this book are all actual experiences of Lifeline Rescue personnel, but the names of the patients and details of the circumstances were changed to protect their privacy. Lifeline EMS Academy has taken care to make certain that the equipment, doses of drugs, and schedule of treatment are correct and compatible with the standards generally accepted at the time of publication. Nevertheless, as new information becomes available, changes in treatment and in the use of equipment and drugs become necessary. Pre-hospital care providers are advised to consult with their Medical Director before using any drug. Lifeline EMS Academy disclaims any liability, loss, injury, or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this book.

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DEDICATION This book was made in honor of all the Filipino Emergency Medical Technicians who labor 24/7 to provide the best prehospital care service in this part of world. 

It is also lovingly dedicated to Filipino young people who aspire to be part of the local and international Emergency Medical Service. 

May this book provide them with a solid foundation in their quest to be real-life heroes – saving the lives of others, and making the world a safer and healthier place.

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UNIT 2 DAY 7

CONTENTS

LIFELINE PREHOSPITAL EMERGENCY CARE

UNIT 4 DAY 26 AM

CRITICAL CONCEPT .

LE         

PAGE

18 Day 1

Basic Life Support

FUNDAMENTALS OF EMT PRACTICE

Day 2

The Emergency Medical Service and the Philippine Healthcare System STANDARD PRECAUTIONS

Day 3

Anatomy As you perform and yourPhysiology initial size-upofofthe Human the scene, there are many important points to consider. One very important aspect of personal protection— Thethat Fundamentals Pathophysiology and one you will needOf long after you have addressed any physical dangers—is Standard Precautions, also called substance isolation (BSI).

Body

110

Day 4 Day 5

Understanding Our Body’s Development

You learned about Standard Precautions and personal protective equipment (PPE) in Chapter. "The WellMoving PatientsTechniques BeingLifting of theand EMT" To summarize: Body substances include blood, saliva, PAGE and any other body fluids or contents. Alt body substances can carry viruses The Scene and bacteria. YourSize-Up patient's body substances can enter your body through cuts or other openings in your skin. They can also easily enter your body through your eyes, nose, and mouth. You are especially at risk of being infected by a paVital Signs and Monitoring Devices tient's body substances when the patient is bleeding, coughing, or sneezing, or whenever you make direct contact with the patient, as in mouth-to-mouth ventilation. Infection is a two-way street, of course. You can also infect the patient.

Day 6

162

180

Day 9

Assessment For example, at a vehicle collision that is likely toInitial have caused severe injuries with bleeding, all personnel should wear protective gloves and eyewear. Since this potential hazard can be spotted before there is any contact with the patient, everyone should be wearing gloves before beginning patient care. If a patient Thinking and requires suctioning or spits up blood, this would Critical be another indication forDecision protective eyewear and a mask, Whenever a patient is suspected of having tuberculosis or another disease spread through the air. wear an N-95 or high efficiency particulate air (HEPA) respirator to filter out airborne particles the patient exhales or expels.

Day 10

A key clement of Standard Precautions is always to have personal protective equipment readily available, either on your person or as the first items you encounter when opening a response kit. Remember that taking proper Standard Precautions early in the call and evaluating the need for such precautions

Making

  

128 138 162 “

in Lifting and Carrying Patients

Day 7 Day 8

 

244

200

² Lim ³ Pol ⁴ Na

tions.

 Read the labels and inspect each type of medication.

INTRODUCTION LIFELINE PREHOSPITAL EMERGENCY CARE

270

Day 11

General Pharmacology

284

Day 12

MBULANCE OPERATIONS IN EMT PRACTICE Respiration and Artificial Ventilation

318

Day 13

Cardiac Emergencies

Day 14

Basic ECG Reading

EARNING OBJECTIVES

EMS OPERATIONS 342

366

Day 15

Diabetic Emergencies and Altered Mental Status

Identify what is essential for completion of a call. State what information is essential in order to respond to a call. Day 16 Discuss the medical and non-medical equipment needed to respond to a call. Abdominal Emergencies Discuss "Due Regard For Safety of All Others" while operating an emergency vehicle. Day 17 Discuss various situations that may affect response to a call. Emergencies in Mentally Disturbed Patients List the phases of an ambulance call. List contributing factors to unsafe driving“ conditions. Day 18 Describe the considerations that should by given to: Request for escorts, FolAllergic Reactions lowing an escort vehicle and Intersections Describe the general provisions of state laws relating to the operation of the 19 in any or all of the following categories: Speed, ambulance andDay privileges Soft Tissue Injuries Parking and Turning Warning lights, Sirens, Right-of-way, Describe how to clean or disinfect items following patient care. Day 20 Differentiate between the various methods of moving a patient to the unit Central Nervous System Trauma based upon injury or illness. Apply the components of the essential patient information in a written report. Dayresponse. 21 Summarize the importance of preparing the unit for the next Chest and Abdominal Distinguish among the terms cleaning, disinfection, high-level disinfection, and sterilization.

388

PAGE

270

As an EMT, you will be trusted with the tsk of administering m gency situations. This important responsibility requires you to making and pay attention to the detail. Although in many tions may be lifesaving. there is the potential to do significant when they are administered incorrectly.

416

428

438

The study of drugs—their sources, characteristics, and effect cology. This chapter introduces the terminology, basic prin garding pharmacology. We will discuss medications EMTs lance and review prescribed PAGE medications you may assist th with approval from medical direction. You will learn the fo your patients may be taking as well as the names for comm tions and why they are used.

512

342

534

TraumaAlthough you will learn many facts and terms regarding med that nothing replaces good judgment and proper decision Day 22 the most important tool you carry is your brain. Environmental Emergencies

NTRODUCTION

552

582

NOTE

Day 23

Obstetric Gynecology Emergencies and Emergency Child Birth Although EMS personnel use the terms medications and dru the public often associates the word drugs with illegal or Day 24 Pediatric Emergencies When dealing with the public, therefore, use the terms m tions.

608

Day 25

Emergencies on Elderly and Specially Challenged Patients

Day 26

EMS Operations PAGE

664

Day 27

664

Multiple Casualty Incidents

² Limmer, O’Keefe, “Emergency Care”, 12th Edition. Brady, NJ (2012) ³ Pollack, “Emergency Care and Transport of Sick and Injured”, 10th Edition. AAOS, MS (2011) ⁴ National Highway and Traffic Safety Administration (NHTSA), “EMT Basic Standard Curriculum“, Departmen

Day 28

Introduction to Advanced Cardiac Life Support

718

Day 29

Intravenous Therapy for Pre-Hospital Providers

Glossary of Important Medical Terms

mmer, O’Keefe, “Emergency Care”, 12th Edition. Brady, NJ (2012) llack, “Emergency Care and Transport of Sick and Injured”, 10th Edition. AAOS, MS (2011) ational Highway and Traffic Safety Administration (NHTSA), “EMT Basic Standard Curriculum“, Department of Transportation, USA, (2005)

640

748

688 732

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PREFACE E

MERGENCY Medical Service, or EMS, in the Philippines is in the process of being institutionalized. As this book gets printed, a bill is being deliberated on in Congress that will provide a system of regulating the EMS profession in the country. Once enacted, the EMS Law will officially make EMS an integral part of the Philippine healthcare system.

As it is right now, EMS in the Philippines is a hodgepodge of protocols and practices copied from more advanced countries, particularly the United States. The EMS bill seeks to improve these practices by establishing a set of uniform standards and by formulating and eventually implementing a national health plan for emergency medical care. Just like EMS in other parts of the world, the EMS in the Philippines evolved from the practices of military paramedics during wars. Although ambulances exist in virtually all cities and towns in the Philippines, the quality of service varies greatly. To make matters more interesting, Filipinos in general do not know what EMS means, much less what to expect from an EMS professional. Over the years, EMS groups have emerged from both the private and government sectors. All of these EMS groups have one common objective -- to save lives. And even with the absence of uniform standards, these groups have tried their best to fill the gap in emergency health care of the country. One of these groups is Lifeline Rescue. Started in 1995 as Lifeline Arrows, our company had this vision: To become the premiere EMS provider in the country. We wanted our ambulances to be virtual emergency rooms on wheels. And we have proven that we could do it. Unbeknown to us, putting up these modern equipment was the easy part; getting the right people to work on the patients was the difficult task.

The main reason for this is because in the Philippines, there was a serious lack of appropriate training for EMS personnel. Trained paramedics were in short supply. It took us a long time to get the best people to man our ambulances. We hired nurses just to get the service going. But we realized that we eventually had to train them ourselves and certify them to our desired standards. This gave birth to Lifeline EMS Academy. With the goal of producing quality ambulance personnel, the Lifeline EMS Academy eventually developed an integrated and comprehensive approach to training EMS personnel. Its syllabus has evolved into a 29-day full-blown EMS course that provides the perfect mix of theoretical and practical learning. After 29 days, would-be EMS personnel were ready to experience actual ambulance work. Our EMS trainees get an average of three calls per day in the six to eight months they stay with us. This daily practice allows our trainees to put their newly acquired knowledge and skill to actual use. Our trainees get to respond to real-life emergencies, ranging from the mundane â&#x20AC;&#x153;KSPâ&#x20AC;? (kulang sa pansin) calls to actual car crashes involving multiple vehicles and dozens of injured victims. All the new things our EMS trainees learn in practice were later on incorporated into the Lifeline Academy lectures. Hence, their training manual soon became a treasure trove of priceless insights into the exciting world of EMS. That training manual has been turned into a book and is now in your hands. We are proud to say that this training manual was initially patterned after the existing curriculum of the National Highway Safety and Traffic Administration in the United States. This curriculum was mixed with the best practices we have accumulated over the last 20 years to come up with truly useful book. It is therefore my distinct honor to present you with this book. It is my hope that this book would help you in your quest to become not only an EMS professional, but one who would always take pride in being a highly capable and thoroughly trained one. In the end, your capabilities and training would enable you to save more lives.

Michael H. Deakin

Managing Director Lifeline Ambulance Rescue Lifeline EMS Academy LIFELINE

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Lifeline Rescue

We Save Lives

INCE 1995, Lifeline has dedicated itself to raising the quality of pre-hospital medical care in the Philippines. Created by a group of doctors, it envisioned the institution of the country’s first professional ambulance service that would respond to distress calls from anywhere within Metro Manila at any time of the day or night. To complement this service, Lifeline has, over the years, established firm relationships with Metro Manila’s finest hospitals.

What We Do Lifeline has a 24-hour dispatch center known as the “Red Room” that serves as the nerve center of our operations. It is equipped with a special 5-digit hotline, 16911, an internationally awarded radio communications network, a computerized database and a detailed map of the entire Metro Manila. At the Red Room, highly trained emergency nurses receive and direct calls, dispatch ambulances based on proximity to the patient’s location, offer support and medical advice, keep themselves updated on the current traffic situation, coordinate with Lifeline’s doctors and, in effect, synchronize the entire daily operations. 8

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Each response team is composed of two licensed nurses (or a licensed nurse and an emergency medical technician) and a transport officer. They are all trained in basic life support at the minimum, and further receive in-house training in advanced life support techniques. Board-certified emergency physicians are on stand-by to provide on-line medical control. These physicians are our member specialists.

When We Fly Lifeline offer Medical Evacuation Service by land, sea or air anywhere in the Philippines. Airlifts are done in coordination with other service providers, mainly private and commercial aircraft. In 2004, during Holy Week, when most doctors were unavailable, one of our emergency physicians, aided by the expert flying skills of a seasoned pilot on board a personal helicopter, performed the rescue of a young lady off Pico de Loro in Ternate, Cavite (where she had fallen and lost consciousness). Another young lady in critical condition was airlifted from Hong Kong to Cebu in record time using a commercial airliner. Most notable was the evacuation by private jet of an unfortunate government official who had suffered a stroke in Baguio and needed to be flown to Manila for further treatment.

Where We Go The resounding success of our Emergency Quick Response (EQR) Program is complemented by Lifeline’s Inter-facility Transport Program (IFT) which provides nonemergency medical transport for patients. Because of the specialized equipment and training of our crew, Lifeline Arrows is the preferred ambulance service of most of Metro Manila’s finest hospitals, as well as those in outlying provinces. Our fleet of Advanced Life Supportcapable ambulances has traveled 10

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as far north as Ilocos Sur and Tuguegarao, Cagayan Valley and as far south as Mindoro in our ceaseless efforts to provide the best medical care on the road.

Who We Cover Lifeline is often called upon to stand by at significant events where the organizers wish to have an ambulance available in case of an emergency. During the Leaders Summit of the Asia Pacific Economic Cooperation (APEC) in 2015, it was Lifeline that served as the official emergency medical service provider. Earlier that year, Lifeline was also the EMS provider for the visit to the Philippines of Pope Francis. Months before the pontiff’s visit, Lifeline served as ambulance backup for United States President Barack Obama in his trip to the country. Of course, Lifeline did not get to this level easily. It took years for the company to achieve this level

of credibility. In fact, as early as 2003, Lifeline has been the official ambulance service provider of dignitaries such as then US President George W. Bush and First Lady Laura Bush in their visit to the Philippines. Our services are not limited by the economic circumstances of our patients. During a routine stand-by in Makati in 2003, our crew noticed a young homeless couple wandering the streets in the pouring rain. The female was doubled over in pain, while her husband was trying to find shelter for them. The Lifeline crew, empowered to save lives, sprung into action! The lady had barely settled down inside the ambulance when her baby was delivered. The baby now carries the name of one of the nurses who helped deliver her.

Hope in Tragedy Over the past decade, Lifeline has been protecting our freeways. Hundreds of lives have been saved

on the South Luzon Expressway, but, sadly, some injuries were just too severe. Such was the case when one member of a highprofile family slammed into the back of a jeepney near the Sucat interchange during the early morning hours. The hood of the car entered the windscreen and pinned the driver, a 38-year-old father of eight, under the steering wheel. When Lifeline arrived on the scene, they found the victim with massive head injuries. Blood pressure was extremely low and injuries sustained were extensive. Our crew worked for an hour and a half to stabilize and extricate him from the car. Largely in thanks to the care he received at the site of the accident, the hospital managed to keep him alive for an additional 12 hours. His family expressed overwhelming gratitude to our crew for keeping him alive long enough to receive the last sacraments.

For Your Convenience Lifeline further offers Home Care for those patients who need or desire outpatient medical care in the comfort of their homes. This is especially beneficial to the chronically ill and disabled or post-operative patients who have difficulty finding their way to the hospital or clinic for a routine medical check up or change of dressing or tube. Working in harmony with the patient’s personal physician, we are able to extend his care at the convenience of both patient and doctor.

Where You Are Because of the demand for Lifeline’s services, we were invited to expand into Clinic Management. At present, Lifeline offers 24-hour ambulatory care complete with diagnostic and x-ray services within the Ayala Alabang Village, making them the first Lifeline-protected

village. Elite schools, such as Beacon School and PAREF Northfield, choose to have Lifeline service their clinics. De La Salle Zobel in Alabang is the first Lifeline-protected school and joins the ranks of other Lifeline-protected property such as Discovery Suites, Citibank Towers, Parque España and Sofitel Philippine Plaza Manila. Yet not all emergencies are high trauma. In our extensive and exclusive coverage of the Metro Rail Transit (MRT), Lifeline has already been called upon twice to deliver babies that could not wait to come out and join the world. Lifeline currently has 200,000 members, ranging from individuals and families to corporate accounts, and covers approximately 3.4 million people on a daily basis under our safety zones. With these multiple, interlinked services which Lifeline offers, it is no wonder that the thought of any emergency conjures up the name of Lifeline, whether or not it be medical in nature. Indeed, it is your lifeline in crisis. LIFELINE

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So you want to be an EMT? 12

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he fact that you are reading this book is indication that you are interested in the Emergency Medical Technician (EMT) profession. Such is a noble and excitement-filled job. It also comes with a sense of a mission Yet it typically demands long hours, involves enormous stress, and oftentimes leave a lasting impact on oneâ&#x20AC;&#x2122;s family and social life.

An EMT’s work is about service to individuals in need. Do you have what it takes to be successful in this field? Here are five qualities that you must have to become a good EMT:

1.1 INTEGRITY The dictionary defines “integrity” as a “firm

adherence to a code of especially moral values.” That code is your personal ethics, a set of standards or principles that govern your behavior. Being true to that code is basically the soundness of your moral character and how honest you are. In Lifeline 16-911, we strictly follow a Code of Ethics, and our people make sure their work is as transparent and as professional as possible. As a future EMT, there would be times when you would find yourself working unsupervised and going into bedrooms and other private areas normally reserved for people close to the patient/s you are trying to help. You and your team would be the only ones in the scene. It is in these times and in these areas that you would be tested. Will you be completely honest? We normally ask our people to wear body cameras as a safety precaution. But remember: Integrity is doing the right thing even when no one is recording, when no one

is looking. If you have integrity, you would do the right thing with or without a body camera.

2.2 COMPETENCE

Integrity is nothing if you do not know what to do. Competence, or the ability to do what need to be done, is the second most important quality of a good EMT. To be certified as an EMT, you only need eight weeks of classroom instruction and 250 hours of on-the-job training. Yet this is only the beginning. As an EMT, you must be a constant learner -- you must learn on the job, from every case you handle, and you must continually review what you know to make sure they are still current and relevant. As a future EMT, you will be required to comprehend and retain a larger volume of information than you would initially learn here in Lifeline Academy. What you would be taught in the Academy are only the “essentials.” Your training will not be over when class is over. To be a good EMT, you need greater discipline for self-directed learning than most jobs in medicine. The Lifeline Academy will give you the bare minimum of knowledge to help you understand the many injuries and illnesses you’d encounter. But the rest of the

TO BE A GOOD EMT, YOU NEED GREATER DISCIPLINE FOR SELF-DIRECTED LEARNING THAN MOST JOBS IN MEDICINE.

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learning will be up to you and it never ends. The bottomline: If you want to be a good EMT, then be good in what an EMT is expected to do.

3.3 PASSION One veteran EMT once said that it is very

difficult to explain to a person with no background on Emergency Medical Service how an EMT is able to wake up in the middle of the night, drive to a place he’s never been to, and help someone he has never met before. Indeed, it takes passion to do the work of a hero. Passion is defined as a strong feeling of enthusiasm over something. In simplest terms, it means loving what you do. The EMT’s work is hard and oftentimes thankless. Yet if you love what you’re doing, then you would always find the reason to go to work every 14

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morning (or every night, depending on your shift), come hell or high water.

4.4 COMPASSION

We all have good days at work, and we all have bad days too. But for people who are born with the right gifts, the EMT profession can be more than just a great job. If you like people, have a feel for their suffering and like taking care of them, your work as an EMT would be a daily source of joy for you. Think about the fact that every single person you meet in an ambulance is someone who’s not as fortunate as you are. They will all be having the worst days of their lives—struggling for every breath, facing the consequences of a stroke, dying of something, grappling with a mental disorder, maybe, or just plainly scared to die.

If you don’t have love for others, and if you see the EMT career as just plain work, then this early we advise you to stop. You will be miserable in the ambulance, and believe us, you will make the lives of your team -- not to mention your patient -miserable too. The rewards received by EMT’s are small and not predictable. If you have no compassion for others, you would eventually take shortcuts, and when you do, you would inevitably make sloppy, deadly mistakes.

PASSION IS DEFINED AS A STRONG FEELING OF ENTHUSIASM OVER SOMETHING. IN SIMPLEST TERMS, IT MEANS LOVING WHAT YOU DO. THE EMT’S WORK IS HARD AND OFTENTIMES THANKLESS. YET IF YOU LOVE WHAT YOU’RE DOING, THEN YOU WOULD ALWAYS FIND THE REASON TO GO TO WORK EVERY MORNING (OR EVERY NIGHT, DEPENDING ON YOUR SHIFT), COME HELL OR HIGH WATER.

5 ABILITY TO WORK AS PART OF A TEAM

You may have the heart to serve sick patients. You may even have the passion to work non-stop. And you may have all the skills to be a very productive EMT. Yet if you do not possess the last quality -- the ability to work as part of a team -- then you would fail in this profession. Why? Just like basketball, the task of providing prehospital emergency care to patients is a team sport. You would not be able to do everything alone. And since you would be working in a team, you have to be team player. If you are naturally inclined to be a team player, then well and good. The EMT profession is fit for you. However, if you grew up as a lone wolf, don’t worry. You

can still develop that team spirit in you. In your eight weeks of Lifeline Academy training, you would have opportunities to work in teams. Take advantage of those opportunities to give and earn trust. Relationships are built on trust. And for your team to be effective, all of you must trust each other. Your training in working as part of a team will continue in your 250 hours of on-the-job exposure. You will experience various tasks and play different roles. The key is to learn as much as you can, as quickly as you can, and adapt to the situation the best you can -- not as an individual EMT but as a team. Remember the meaning of the word TEAM in Lifeline. TEAM -- Together Everyone Achieves More. In Lifeline 16-911, together you will be saving more lives.

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UNIT 2 DAY 7

member of the EMS team.

How To Use This Book

FOUNDATION OF EMT PRACTICE

INTRODUCTION TO EMS MEDICAL,eLmifeeLringeenPrehosPitaL cy care LEGAL AND ETHICAL ISSUES

ARNING OBJECTIVES

T-Basicstudents, this book is the EM a pra guidecticfore of Lifeline Academy ● Define the scopeS of R] (advance directives) e [DN itatthe uscof nce of designed to Do makeNothet Res study basic principles ● Discuss the importa EMS system. ing Medical ard reg s tion ula reg and ons visi pro l and techniques in the Emergency Service (EMS) and loca ds of obtainmetho and s nce ere diff the s cus Dis t. sen con as easy as possible. ● Define the termprofession ing each consent. UNIT 2

DAY 7

We have culled the most important principles from various books and condensed them into 29 chapters, which represent 29 days. Every chapter is focused on a particular area, and is divided into the following parts:

TRODUCTION

FUNDAMENTALS OF EM

STANDARD PRECAUTIONS

UN DA

As you perfo the scene, th points to co tant aspect and one that you have add gers—is Stan called substan

You learned tions and pe ment (PPE) i Being of the Body substanc and any other Alt body subst and bacteria. Y stances can en cuts or other openings in you r skin. They can also easily en your eyes, nose, and mouth . You are especially at risk of tien t's bod s. ine y sub del stances when the patient legal, and ethical guiwhenever is bleeding, cou EMTs are governed by many medical, you make directthe pe This summarizes important con sco tact with ideas a as to the patient, as in rred refe be y ma ons lati rati on. side Infe con n isthe a two s and ethical -waywill strelearn or skillsctio that student et, of from his set of regulation course. You can also This gives the student an idea of T’s job. The skillstheand EM an of ts limi and ent ext chapter. the s ine defchapter seeks to accomplish. ich the f practice, whwhat For mple, at a vehicle collision form perexa that is likely to have caus p the patient) the EMT may ble helthe provides a quick lookdo intoto what at you ns (wh edi ntio ng,ntall personnel should medical interveThis ere diff we es ar protective gloves an etim Som e. stat to e student will learn by the end of thefrom day. stat potential hazard can be spo tted before there is any con re defined by legislation, which varies s. ine del eve gui ryo ne should be wearing glo e different rules and ves before beginning pa egions within the same state may hav requires suctioning or spits up blood, this wo“ uld be ano the tive eyewear and a mask, Wh 16 LIFELINE PREHOSPITAL EMERGENCY CARE enever a patient is suspected or another disease spread through the air. wear an N-95 ticulate air (HEPA) respirator to filter out airborne particl es expels.

“

LEARNING OBJECTIVES

. CRITICAL CONCEPTS

Scope of Practice

1. Legal duties to the patient, medical

director, and public “ A ry keyinte clemr-en rendering necessa

7 DAMENTALS OF EMT PRACTICE INTRODUCTION FUN

NDAMENTALS O

F EM

NATURE OF THE CALL

esponse to Danger: OBSERVE

a. Survey scene on approach lights and siren b. don’t announce arrival – turn off you can see front and sides c. drive few feet past residence so d. violence e. alcohol or drug use UNIT 1 f. weapons DAY 1 g. family members h. bystanders i. perpetrators CRITICAL CONCEPTS j. pets

FOUNDATION OF EMT

After you safety and Standard P tant to de the call by PRACTICE nism of inju patient's illn

4. If the AED advises a shock, it will tell you to clear the victim. •Clear the victim before delivering the shock: be sure no one is touching the victim. •Loudly state a "clear the victim" message, such as "Everybody clear" or Defibrillation simply "Clear." Thenom •Look to be sure one the victim. When ventricular fibrillation is preecishainnicontact sm ofwith injury what look Since there will be sent, a lottrie of heart things to learn in the chapter, we the SHOCK serves as ais broad •Press muscle fibers quiver causinto causbutton. es an injury (e.g es the knThis During the (1790) Napoleonic Wars, injured soldiers were transported ee s to and strikeconnects .. •The shock will producethe a sudden contraction ofethe muscles. and do not contract together to th davictim's sh have chosen important terminologies that the student must be chapter the chapter of th a e car: a fall on ice ca an kle ). Certain injuries from the battlefield to be cared pump for by physicians. Thedelivers civil war saw the beginblood. A defibrillator u ar e co ns id familiar with in order to understand the chapter better. with the other parts of the book. ered "common" to ries to 5. If went no shock needed, andbo after electric shocklike to stop theBarton, quiv- who nesanyanshock ning of organized medical care an with people Clara onis to d jodelivery, part ints areimmediately resume buchest startingthe with compressions. ering of the heart fibers. This alrns ar e common to fires usually associated with falls a establish the American Red Cross. Immediate care in field hospitalsCPR, behind an d lows the muscle fibers of the heart ex plosions; penetra lines by train was also pioneered. In World War I, volunteer ambulance person-associated with ting softnsthe hoAED 6. After 5 cycles or about 2 minutes of gu CPR. willnd prompt you to repeat to "reset" so that they can begin to t wou s, and so on. nel assisted in the transport of contract the wounded to time. hospitals. Korean War, 3 and 4. at the same Once anIN the steps Mobile Army Surgical Hospital (MASH) wereoccurs, used, and organizedunits rhythm the in both Korea andEven if you cannot de termine the exac NOTE: wars alsoing the mecha heart used musclefor maythe begin to con- These t injury the pa Vietnam, helicopter transport was wounded. nism of injury may tract effectively and begin to genallow you to pred tient h ex am brought about the development of civilian hospitals specializing in the treatple, in many situa ict various erate a pulse (called return of If "no shock advised," immediately restart CPR beginning with chest comprestions yo uw ill im mechanism of in mobilize the patie ment of trauma. Non-military ambulance services orbegan in early spontaneous circulation, ROSC). Operating sions. jury, such as nt'

Mechanism of In

R’s reeMedical The Emergency Services System er: ng React to Da KEYThTERMS RETREAT

OVERVIEW

jury (MOI)

a forceful blow, injury. You do no 1900 in US; No requirements or standards for equipment, crew training, or amis frequently as t need to know that the patient's assume il is and bulance design – “You call, we haul, that’s all!” spine is a treat accordingly. Foundational Facts Knowing that th you to check for e patient h an injured arm or leg. In 1966, the National Highway Safety Act developedImportance EMS standards of Minimizing Time Between Last Compression and Shock Delivery CE TIprehospital C A PR T EM M and assisted states in upgrading the quality of their emergency care. ot F or O 2 Ve T LS hicle Collisions Id NI TA DAMENof entif FUN yinafter Analysis of thousands strips recorded before and delivery g thshock The establishment EMS standards was spurred by the 1966 government wheof e mec n rhythm dealing hanism of injury w AY 10 mbetween otor -vehi has shown that if rescuers can theith time lastco compression and Phil isthecle the cartoon white paper “Trauma: The Neglected Disease of Modern Society.” It dealt with steering cokeep llis io ns . Fo lu r example, a m n su gg shock delivery to 10 seconds or less, the shock ists much more likely developed to be effective es th at hin wit th EMT that we have io to inadequate emergency e driver hacirculathe high number of deaths from traffic collisions due possiblefibrillation mobile rad s rib su or (ie, to eliminate ventricular and result in return of spontaneous ffered a between the “ ev de ma en e re lu we hav s ng on issi this was considered hearto , when you se transm medical Since a ber highway safety issue tion). at the time, EMS t da in thisorbook translate shield points to mage. A shattere che ty of thecare. tion. Remem A majori the ambuth patcher at a base sta ve e dis lea lik the eli you and ho ver ce od ene lan amisburegulated by the you wh Traffic Safetys Administration. Highway The NREMT a forehe important of concepts toad theor scalp d, bloo severe blow to th lorm yourtheinit le radio with tabNational ialilabsize g you -up if hazard or mu e hesignificantly -up laceratio le, brin of r por scene size ad ring th one ava du Effectiveness of shock delivery decreases for every additional 10 at nce m ut ista ay ho (1970) established national standards for testing and certifying EMS personnel. ass wit ha t for This more interesting to the ve caus tha call will make the chapter local language. Every time here are lan need to ed a head or spin mayort ma Youimp io allows you to do ce.ny rad le seconds that elapses between last compression and shock delivery. Minimizing ant tab por a the and it.ofestablish The NEMSSA made funds and EMS Th sys-e law of found,(1973) are the fixed unto student as it explains the what he or sheupgrade willinterval ients to seeteam Phil,coordination, you will read onavailable onsider. On call importance tipleepat this will require practice and particularly iner ver tiaexcellent yknationwide. imp —t bulance to make the orha am t the a 10 bo dy bac tems g in motion of runnin upon byand learn during the day. between the compressor rescuer the defibrillator. the Tagalog summary of person antheou al protection tside operating fo — rce (e.g., being sto will remain in mo why there are ac pped by striking t you will need long after the things you tually three collis need to som Sa pagbibigay ng kuryente na ions involved in first collision is th dressed any physical danunderstand. each motor-v e ve hi cle ² Limmer, O’Keefe, “Emergency Care”, 12th Edition. Brady, NJnaayon (2012) sa kondisyon ng str iki ng an object. The se patient's body str “Emergency Care and Transport of Sick and Injured”, 10th Edition. AAOS, MS (2011) ndard Precau³ Pollack, cond collis pasyente, siguraduhin na ang tions, ikes the interior alsoand Traffic Safety Administration (NHTSA), ⁴ National Highway “EMT Basic Standard Curriculum“, Department of Transportation, USA, (2005) of the vehicle. Th the organs of the nce isolation (BSI). mga kasama ay hndi nakadikit e third collis patient strike surfa ces within the bo ditto, walang metal na nakady. suot o dikit sa pasyente at higit Identifying the ty about Standard Precaupe of motor-vehi sa lahat, ipaalam sa kasama cle collision also tion on potential ersonal protective equipprovides imp kung ikay magbibigay na ng injury patterns: “shock”. Itaas ang dalawang in Chapter. "The Wellkamay habang sinasabi ang e EMT" To summarize: salitang “CLEAR” ces include blood, saliva, r body fluids or contents. tances can carry viruses Your patient's body subnter your body through nter your body through being infected by a paughing, or sneezing, or n mouth-to-mouth ventiN O COMMUNICATIO o infect the pat ienCIP t. LES OF RADI PRIN

MT PRACTICE

INTRODUCTION

PHIL’S CORNER

RADIO

REEVALUATE

FOUNDATION FACTS

tem:

ng the EMS Radio Sys

LIFELINE IN ACTION

les when usi properly. ² Limmer (Brady) se princip sed severe inju ume is adjusted Follow are the important knowledge that the end of key chapters, we included actual case riesthe and the vol wit h surThese ³ Pollack,At (AAOS) that your radio is on when possie dow ke win Ma icle ⁴ NHTSA “BLS for Healthcare Providers”, Student Manual (2010): 6-17.  vehhe or she can nd eyewear. Since this the ¹ American Heart Association. g sin clo as student must first know before histories contributed by Lifeline Rescue graduates to fully by ise nd no  Reduce backgrou ntact with the pat a ing proceed with the chapter. illustrate how certain skills are applied. inn beg ien t, ore . bef ble is clear and ensure that it atient care. If a patien t to the frequency  Listen . it 1 second er indication for protec transm 17 LIFELINE PREHOSPITAL EMERGENCY CARE the radio, then wa - ission " (PTT) button on words of your few t firs ss the "press to talk the of having tuberculoPre off cutting ts ven pre sis s Thi . before speaking or high efficiency par hone. tra-nsmission. hes Irom the microp the patient exhales Spe or lips about 2 to 3 inc their unit number  or ak with your use , tion sta e bas or



ther unit When calling ano this is Ambulance 2." yours. "Dispatcher, should start by name, followed by t the transmission

LIFELINE PREHOSPITAL EMERGENCY CARE

BASIC Life Support (BLS) is the primary medical aid provided to a person in an emergency medical situation. As a future Emergency Medical Technician (EMT), this procedure is the first you are expected to give and can prove to be very helpful when it comes to saving the life of an individual. It is important to understand that the objective of BLS is not to â&#x20AC;&#x2DC;treatâ&#x20AC;&#x2122; the person but to buy some valuable time until the emergency medical aid arrives. BLS procedure is mainly used on people experiencing cardiac arrest or respiratory failure. With this procedure, the breathing and heartbeat of the person can be resuscitated. However, it is important to provide professional medical care to the patient. While BLS procedure can be very useful, it is important to provide it in the right manner. For this reason, we in Lifeline Academy devoted our first day of class on this topic.

LIFELINE

PREHOSPITAL EMERGENCY CARE

DAY

Basic Life Support Adult Chain of Survival BLS / CPR for Children Ventilation with Barrier Devices Relief of Choking

LIFELINE

PREHOSPITAL EMERGENCY CARE

Day 1

CRITICAL CONCEPTS Basic Life Support is generally used in the prehospital setting, and can be provided without medical equipment.

FOUNDATION OF THE EMT PRACTICE

Basic Life Support

KEY TERMS � Basic Life Support (BLS) — is the level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel and lay persons. � Resuscitation — Restoration of life or consciousness to one who appears to be dead.

LEARNING OVERVIEW OBJECTIVES Ang CPR o cardiopulmonary resuscitation ay ang pagbabalik ng sirkulasyon ng dugo at paghinga ng pasyente sa pamamagitan ng paulit-ulit na pagdiin sa kanyang dibdib at pagbuga ng hangin sa kanyang bibig.

After going through this day, you will learn the most basic part of Emergency Medical Servic.e

The Lifeline Academy follows the 2015 Guidelines of the American Heart Association (AHA) for Cardiopulmonry Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) which recommend the following: • Changes in Basic Life Support (BLS) sequence; • Continued emphasis on high-quality CPR, with minor changes in compression rate and depth; • Additional changes regarding cricoid pressure, pulse check, and Automated Electronic Defibrillator (AED) use in infants

Change in Sequence: C-A-B, Not A-B-C

The 2015 AHA Guidelines for CPR and ECC recommend a change in the BLS sequence of steps from A-B-C (Airway, Breathing, Chest compressions) to C-A-B (Chest compressions, Airway, Breathing) for adults, children, and infants. This change in CPR sequence requires re-education of everyone who has ever learned CPR. In the A-B-C sequence, chest compressions were often delayed while the rescuer opened the airway to give mouth-to-mouth breaths, retrieved a barrier device, or gathered and assembled ventilation equipment. By changing the sequence to C-A-B, rescuers can start chest compressions sooner, and the delay in giving breaths should be minimal (only the time required to deliver the first cycle of 30 chest compressions, or approximately 18 seconds or less; for 2-rescuer infant or child CPR, the delay will be even shorter).

LIFELINE

PREHOSPITAL EMERGENCY CARE

NOTE: Most of the information contained in this chapter were from the book “BLS for Healthcare Providers Student Manual” published by the American Heart Association in 2010. Used with permission from the publisher.

INTRODUCTION Welcome to Lifeline Academy. The first day of our 29-day course is focused on the most important aspect of the Emergency Medical Service (EMS) profession - saving lives. Here you will learn how to do cardiopulmonary resuscitation (CPR) for victims of all ages and will practice it in a team setting. You will learn how to use an automated external defibrillator (AED) and how to relieve choking. The skills you learn in this course will enable you to recognize emergencies such as sudden cardiac arrest and know how to respond to them. Cardiac arrest remains a substantial public health problem and a leading cause of death in the Philippines. Each year, some 170,000 Filipinos die from cardiovascular diseases, according to the Department of Health. Many of these people have a cardiac arrest yet do not receive attempted resuscitation. This is the reason why recently, lawmakers came up with what is now called as the Samboy Lim Law to require mandatory CPR training for students in high school and colleges. For more information about this law, read the end of this chapter.

Emphasis on High-Quality CPR The 2015 AHA Guidelines for CPR and ECC once again emphasize the need for high-quality CPR, including • A compression rate of at least 100-120/min (this is a change from “approximately” 100/min). • A compression depth of at least 2-2.5 inches or 5-6 cm in adults and a compression depth of at least one third of the anterior-posterior diameter of the chest in infants and children. This is approximately 1.5 inches [4 cm) in infants and 2 inches (5 cm) in children. Note that the range of 1.5 cm to 2 inches is no longer used for adults, and the absolute depth specified for children and infants is deeper than in previous versions of the AHA Guidelines for CPR and ECC. • Allowing complete chest recoil, minimizing interruptions in compressions, and avoiding excessive ventilation continue to be important components of high-quality CPR. To further strengthen the focus on high-quality CPR, the 2015 AHA Guidelines for CPR and ECC stress the importance of training using a team approach to CPR. The steps in the BLS Algorithm have traditionally been presented as a sequence to help a single rescuer prioritize actions.

CRITICAL CONCEPTS For victims of all ages (except newborns), begin CPR with compressions (C-A-B sequence). After each set of chest compressions, open the airway and give 2 breaths.

KEY TERMS � Emergencies — an urgent need for assistance � EMS (Emergency Medical Service) — are a type of emergency service dedicated to providing out-ofhospital acute medical care, transport to definitive care, and other medical transport to patients with illnesses and injuries which prevent the patient from transporting themselves.

Sa lahat ng edad maliban sa sanggol, simulan ang “CPR” sa ganitong pagkakasunodsunod (C-A-B)

There is increased focus on providing CPR as a team because resuscitations in most EMS and healthcare systems involve teams of rescuers, with rescuers performing several actions simultaneously. For example, one rescuer activates the emergency response system while a second begins chest compressions, a third is either providing ventilations or retrieving the bag-mask for rescue breathing, and a fourth is retrieving a defibrillator and preparing to use it.

No Look, Listen, and Feel Another key change is the removal of “look, listen, and feel for breathing” from the assessment step. This step was removed because bystanders often failed to start CPR when they observed agonal gasping. The healthcare provider should not delay activating the emergency response system but should check the victim for 2 things simultaneously: response and breathing. With the new chest compression- first sequence, the rescuer should activate the emergency response system and begin CPR if the adult victim is unresponsive and not breathing or not breathing normally {only gasping) and has no pulse. For the child or infant victim, CPR is performed if the victim is unresponsive and not breathing or only gasping and has no pulse. LIFELINE

PREHOSPITAL EMERGENCY CARE

Day 1

CRITICAL CONCEPTS Cardiopulmonary resuscitation (CPR) should be done in a C-A-B sequence, meaning compression-airway-breathing.

� Cardiac Arrest — This is the cessation of functional circulation of the blood due to failure of the heart to contract effectively.

Laging tandaan ang kahalagahan ng tamang diin sa dibdib at pagbibigay ng nararapat na dami ng hangin upang maging epektibo ang ginagawang proseso ng pagCPR.

 Defibrillation— The use of a

carefully controlled electric shock, administered either through a device on the exterior of the chest wall or directly to the exposed heart muscle, to normalize or restore the rhythm of the heart.

PREHOSPITAL EMERGENCY CARE

Understanding the Basics BLS consists of these main parts:  Chest compressions  Airway  Breathing  Defibrillation

Overview of Initial BLS Ste

these initial BLS steps for ad LEARNING Introduction to the Follow 1. Assess the victim for a respon Adultfield Chain of Survival  Pediatric—The of medicine OBJECTIVES If there is no response and no that is concerned with the

A Chain of Survival has been developed by the American gasping), shout for help. Heart Association to provide metaphor for the After reading this health of infants, children, and a useful 2. If you of are alone, activate the e elements of growth Basic Life and Support. A strong Chain Survival section you willadolescents; their (or defibrillator) if available an can improve the chances of victims of heart attack, stroke and be able to name and their opporother emergencies. the links in thedevelopment; 3. Check the victim's pulse (take tunity to achieve full potential American 4. If you do not definitely feel a Survival are: as adults. The four links in the Adult Chain ofcompressions Heart Association and breaths (30 • Immediate recognition of cardiac arrest and activation (AHA) adult sequence). of the emergency response system. Chain of Survival network of resuscitation (CPR) with an • EarlyAcardiopulmonary and state the Definitive Care— facilities that can provide specemphasis on chest compressions. importance of trum of care for injured pa• Rapid defibrillation. each link. Step 1: Assessment and Sc • Effective advanced life support

The first rescuer who arrives at the scene is safe. The rescuer should th

Siguraduhing ligtas Chain ang of Survival Introduction to the Pediatric 1. Make sure the scene is safe for paligid para sa iyo, sa iyong

Although in adults cardiac arrest is often sudden and resultsand fromthe a cardiac victim. You do not wa grupo at pasyente bago simucause, in children cardiac arrest is often secondary to respiratory failure and shock. become a victim yourself. lan ang pagbibigay lunas, to reduce the Identifying children with these problems is essential likelihood of 2. Therefore, Tap the victim's shoulder and s upang maiwasan pediatric cardiac arrest and maximize ang survivalkapaand recovery. a prevention link is added hamakan in the pediatricna Chain of Survival: "Are you all right?" maring mag• • • •

LIFELINE

OVERVIEW

This section describes the bas adolescents (ie, after the onset o underarm hair in males and any b

KEY TERMS

� Assessment — A provider’s evaluation of the condition based on the patient’s subjective report of the symptoms and the examiner’s objective findings, including data obtained through physical examination and information reported by family members and other health care team members.

At the end of this section you will  Tell the basic steps of CPR  Show the basic steps of C

Adult Chain of Survival

KEY TERMS

Although basic life support is taught as a sequence of distinct steps to enhance skills retention and clarify priorities, several actions should be accomplished BASIC LIFE SUPPORT simultaneously (eg, begin CPR and activate the emergency response system) when multiple rescuers are present.

palala ng sitwasyon.

Check to see if the victim is bre

Prevention of arrest If a victim is not breathing or n Early high-quality bystander CPR breathing normally (ie, only ga Rapid activation of the EMS (or other emergency response) system you must activate the emerge Effective advanced life support (including rapid stabilization and response system. transport to definitive care and rehabilitation)

be able to R for adults CPR for adults

sic steps of CPR for adults. Adults include of puberty). Signs of puberty include chest or breast development in females.

s of BLS

Adult CPR

dults: nse and look for normal or abnormal breathing. these initial BLS steps adults: o breathing or Follow no normal breathing (ie,foronly

Overview of Initial BLS Step

1. Assess the victim for a response and look for normal orsystem abnormaland breathing. there is no emergency response get anIf AED response and no breathing or no normal breathing nd return to the victim. (only gasping), shout for help. e at least 5 but than 10 seconds). 2. Ifno youmore are alone, activate the emergency response pulse within 10 seconds, cycles of if system and get perform an AED (or5defibrillator) available andcompressions return to the victim. 0:2 ratio), starting with (C-A-B 3. Check the victim’s pulse and breathing simultaneously (take at least 5 but no more than 10 seconds). 4. If you do not feel any pulse or breathing within cene Safety10 seconds, perform 5 cycles of compressions and breaths (30:2 ratio), starting with compressions e side of the victim quickly be sure that the (C-A-Bmust sequence).

hen check the victim for a response:

r you ant to

shout,

eathing. not asping), ency

LEARNING OBJECTIVES At the end of this section you will be able to • Tell the basic steps of CPR for adults. • Show the basic steps of CPR for adults.

OVERVIEW

This section describes the basic steps of CPR for adults. Adults include adolescents or teenagers in the onset of puberty. Signs of puberty include underarm hair in males and breast development in females.

Understanding the Basics of BLS BLS consists of these main parts: • • • •

Chest compressions Airway Breathing Defibrillation

First Step: Assessment and Scene Safety The first rescuer who arrives at the side of the victim must quickly be sure that the scene is safe. The rescuer should then check the victim for a response: 1. Make sure the scene is safe for you and the victim. You do not want to become a victim yourself. 2. Tap the victim’s shoulder and shout, “Are you all right?”

CRITICAL CONCEPTS In Basic Life Support, you must realize early on that there are several actions that should be accomplished simultaneously to be able to better serve the patient. Teamwork and coordination is absolutely necessary.

KEY TERMS � Defibrillation — The use of a carefully controlled electric shock, administered either through a device on the exterior of the chest wall or directly to the exposed heart muscle, to normalize or restore the rhythm of the heart. � Pediatric — The field of medicine that is concerned with the health of infants, children, and adolescents; their growth and develop-ment; and their opportunity to achieve full potential as adults. � Definitive Care — A network of facilities that can provide a spectrum of care for injured patients. Siguraduhing ligtas ang paligid para sa iyo, sa iyong grupo at pasyente bago simulan ang pagbibigay lunas, upang maiwasan ang kapahamakan na maring magpalala ng sitwasyon.

LIFELINE

PREHOSPITAL EMERGENCY CARE

uer begins chest compres, a third is either providing lations or retrieving the bagfor rescue breathing, and a h is retrieving a defibrillator preparing CRITICAL to use CONCEPTS it). This se focuses on team-based

In most of the cases that you will respond to as an EMT, the CPR will involve your team and each of you should perform several actions simultaneously. One rescuer would activate the emergency response system while a second rescuer would begin chest compressions. A KEYthird TERMS is either providing ventilations or retrieving the bagmask for rescue breathing. And a fourth gonal gasps are not normal is retrieving a defibrillator and reathing. Agonal preparing togasps use it. In may Lifeline Academy, we on Team CPR. e present in the firstfocus minutes

ter sudden cardiac arrest. lgorithm- An algorithm is an KEY TERMS fective method expressed as finite list of � well-defined Agonal gasps are not normal breathing. Agonal structions for calculating a gasps may be present in the unction. Starting fromafter an sudden first minutes itial state and initial input, cardiac arrest. ventually producing "output" � Algorithm — An algorithm nd terminating at a final is an effective method nding state. expressed as a finite list of

well-defined instructions for calculating a function. Starting from an initial state and initial input, eventually producing “output” and terminating at a final ending state.

halagang makatawag kaaMahalagangtulong d ng karampatang makatawag kaagad ng ang matiyak na ang ginagakarampatang tulong ng lunas saupang pasyente matiyak naay ang dudugtunganginagawang pa ng mas lunas sa pasyente ay a nakakaalam.

madudugtungan pa ng mas mga nakakaalam.

LIFELINE

PREHOSPITAL EMERGENCY CARE

Step 4 If a victim is not breathing or there is no normal breathing (ie, only agon CRITICAL CONCEPTS gasps), you must activate the emergency response system, check the pul (CPR— and start CPR. Day 1

Common mistakes throughout all the skills check offs include: BASIC LIFE SUPPORT

Caution: Agonal Gasps 

Trying to memorize steps without Response understanding why Step 2: Activate the Emergency System you are doing what you are AED Gasping (Automated External Device) is different from breathing. doing A person who gasps may look like he is

The lo sions t

When andfast, Getat comple Begin

drawing air in very quickly. His mouth may be open and the jaw, head, or neck may move. Hisalone gasps may appear or weak. They mayvictim sound like snore, or shout for hel If you are and findforceful anunresponsive notsnort, breathing, Forgetting to check scene groan. But gasping is not normal breathing. It is a sign of cardiac arrest the in someone who no doesn’t one respond. responds, activate the for emergency response system, get an AED safety

defibrillator) if available, and then return to the victim to check a pulse and be If a victim is not breathing at all, not breathing normally, or only gasping, you must CPR (C-A-B sequence).  Skipping or combining parts activate the emergency response system, check the pulse, and start CPR.

because you think it will save time

Step Check Step3:2:Pulse Activate the Emergency Medical System

Healthcare should takeChecking no more than 10(AED) secondsor to check for a pul and get providers an automated external defibrillator for breathing If you are alone and find an unresponsive victim breathing, for help. If no pulse fornot too shortshout a time

one responds,the activate the emergency medical system, get an AED if available, and then Locating Carotid Artery Pulse



return to the victim to check a pulse and begin CPR in the C-A-B sequence.

Anticipating what will happen next and skipping ahead To perform a pulse check in the adult, palpate a carotid pulse (Figure 5). If you

3: Pulse feel anda breathing check do Step not definitely pulse within 10 seconds, start chest compressions. Getting soforbusy the You should take no more than 10 seconds to check a pulsewith and breathing simultaneously. physical steps that you forget

Follow these steps to locate the carotid artery pulse: to have someone call 911 1. Locating Locate the trachea, using 2 or 3 fingers the Carotid Artery Pulse 2. Slide these 2 or 3 fingers into the groove between trachea adult,Describing to theIfinstructor To perform a pulse check in the palpate a carotid pulse. youthe do not feel a and the m cleswithin at the side ofstart thechest neck, where feel the carotid pulse (Figure 5 pulse 10 seconds, compressions. what you you can should be doing 3. Feel forthese a pulse for at least 5 but nopulse: more than 10 seconds. If you do not Follow steps to locate the carotid artery of doing it 1. definitely Locate the trachea, 2 orbegin 3 fingersinstead feel ausing pulse, CPR, starting with chest compressions (C-A-B 2. Slide these 2 or 3 fingers into the groove between the trachea and the muscles at sequence). to use protective the side of the neck, where you  can feelForgetting the carotid pulse. 3. Feel for a pulse for at least 5 but no more than 10 seconds. If you do not definitely equipment (breathing barfeel a pulse, begin CPR, starting with chest compressions (C-A-B sequence).

rier / pocket mask and gloves)

Tandaan ang apat na senyales na tama ang ginagawang CPR: 1. bombahin ng madiin at mabilis ang dibdib na may sinusundang ritmo. 2. Hayaang makabalik ang dibdib sa dating itchura o porma tuwing pagkatapos ng isang pagbomba 3. Limitahan ang paghinto sa pagbomba sa dibdib 4. Huwag hayaang sumobra ang bigay ng hangin.

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

Ches

The fou chest c 1. 2.

3. 4. 5. 6.

4: Begin Cycles of 30 Chest Compressions nal lse, —Cardiopulmonary Resuscitation)

and 2 Breaths

one rescuer should use the compression-ventilation ratio of 30 compresto 2 breaths when giving CPR to victims of any age.

CRITICAL CONCEPTS

you giveStep chest important to push the chest hard and Common mistakes committed by 4: compressions, Begin cycles of it30is chest student EMT’s in learning a skill tan a rate ofcompressions at least 100and compressions per minute, allow the chest to recoil two breaths include: etely after each compression, and minimize interruptions in compressions. � Trying to memorize steps The lone rescuer should use the compression-ventilation ratio of 30 compressions to without understanding why they with chest compressions. 2 breaths when giving CPR to victims of any age.

lp. If When you give chest compressions, it is important to push the chest hard and fast, (or at a rate of at least 100-120 compressions per minute, allow the chest to recoil completely egin after each compression, and minimize interruptions in compressions. Begin with chest A. Place your hands on the breastB. Correct position of the Rescuer compressions. bone in the center of the chest during Chest Compressions

lse.

mus5B).

Chest Compression Technique The foundation of CPR is chest compressions. Follow these steps to perform

st Compression Technique chest compressions in an adult:

1. Position yourself at the victim’s side.

are doing what they are doing. � Forgetting to check the scene for safety. � Skipping or combining parts because they think it will save time. � Checking for breathing or pulse for too short a time. � Anticipating what will happen next and skipping ahead. � Getting so busy with the physical steps that they forget to have someone call Lifeline 16-911. � Describing to the instructor what they should be doing instead of doing it. � Forgetting to use protective equipment. Tandaan ang apat na senyales na tama ang ginagawang CPR: 1. Bombahin nang madiin at mabilis ang dibdib na may sinusundang ritmo. 2. Hayaang makabalik ang dibdib sa dating hitsura o porma tuwing matatapos ang isang pagbomba. 3. Limitahan ang paghinto sa pagbomba sa dibdib. 4. Huwag hayaang is sumobra ang bigay ng hangin.

victimcompressions. is lying face-up on a firm, flat surface. victim lying undation2.ofMake CPRsure is the chest Follow theseIf the steps tois perform facedown, carefully roll him faceup. If you suspect the victim has a head or neck compressions in try antoadult: injury, keep the head, neck, and torso in a line when rolling the victim to a Position yourself at the victim's side. face-up position. 3. Putthe the heel of one is hand on thefaceup center of the chest on the lower halfIfofthe the victim Make sure victim lying onvictim’s a firm, flat surface. breastbone. lying facedown, If you suspect the victim has a 4. Put the heel carefully of your other roll handhim on topfaceup. of the first hand. 5. Straighten your arms and position your shoulders directly over hands.in a line when head or neck injury, try to keep the head, neck, andyour torso 6. Push hard and fast. rolling the victim a faceup position. • Press downto at least 2 to 2.5 inches or 5 to 6 cm with each compression (this requires hard work). each chestcenter compression, makevictim's sure you push straight Put the heel of one handForon the of the chest on the down on the victim’s breastbone. lower half of thecompressions breastbone. • Deliver in a smooth fashion at a rate of at least 100-120/min. At theof endyour of eachother compression, make youof allow thefirst chest hand. to recoil (re-expand) Put the7. heel hand onsure top the completely. Chest recoil allows blood to flow into the heart and is necessary for chest Straighten your arms and position your shoulders directly over your compressions to create blood flow. Incomplete chest recoil is harmful because it hands. reduces the blood flow created by chest compressions. Chest compression and chest recoil/relaxation Push hard and fast. times should be approximately equal.  Press down at least 2 inches (5 cm) with each compression (this LIFELINE requires hard work). For each chest compression, make sure you push straight down on the victim's breastbone (Figure 6B).  Deliver compressions in a smooth fashion at a rate of at least 100/

PREHOSPITAL EMERGENCY CARE

UNIT 1 UNIT 1DAY 1 DAY 1 PARAAN NG CPR: Day 1 1. Tsekin ang estado ng kamalayan ng NG pasyente, PARAAN CPR: PARAAN NG CPR: 1. Suriin ang estado ngbeses tapikin ng dalawang 1. NG Tsekin ang estado CPR: kamalayan ng pasyente. andPARAAN parehong balikat hang ka1. Tapikin Tsekinmalayan ang estado ng ng pasyente, ng dalawang beseskabang binubulong sa dalawang magmalayan ng tapikin ngpasyente, beses ang parehong balikat habang kabilang tenga ang “Sir/ tapikin ng dalawang beses and parehong balikat habinubulong sa magkabilang andOkay parehong balikat Ma’amtenga ka langha- sa magbang binubulong “Sir/Ma’am, bangang, binubulong sa okay magba?” (tumawag ng tulong) tenga ang “Sir/ kakabilang lang kabilang ba?”tenga ang “Sir/ Ma’am Okay ka lang 2. Kapain ang pulso sa ban2. Tumawag ng tulong at Ma’am Okay ka lang ba?” ng tulong) dang ipakuha leeg(tumawag ng (tumawag pasyente ba?” ng tulong) ang Automated 2.pinakikiramdaman Kapain ang sapulso 2. External Kapain ang pulso bansa banDefibrilator habang dang leeg ng pasyente dang leeg ng ang (AED). kanyang paghinga, pasyente habang pinakikiramdaman habang pinakikiramdaman 3. Kapain ang pulso obserbahan ang sa dibdib ang ang kanyang paghinga, kanyang paghinga, bandang leeg ng pasyente kung obserbahan ito’y obserbahan umaangat o ang dibdib ang dibdib habang pinakikiramdaman kung ito’y umaangat o hindi. ang kung ito’y umaangat o kanyang paghinga, hindi. 3. Kung sa iyong pagobserba hindi. obserbahan ang dibdib kung 3. Kung sa iyong pagobserba ay wal itong pulso Kung sa iyong pagobserba ito’y o hindi. ay3. umaangat wal itong pulsoat at ay wal itong pulso at hiniga, ilagay angpagobserba ibabang hiniga, ang ibabang 4. Kung sa ilagay iyong hiniga, ilagay ang ibabang bahagi ng palad ng isang walapalad itong pulso at bahagiayng ng isang kamaybahagi sa gitna ngibabang dibdibng isang ng palad hininga, ilagay ang kamay ng sa pasyente gitna ng dibdib . sa gitna ng dibdib kamay bahagi ng palad ng isang ng pasyente . ang 4. Ipatong isa pang nggitna pasyente . kakamay ng dibdib may sasanauna at ito’y pag4. Ipatong ang isa pang 4. Ipatong ang kaisa pang kapasyente . may sangsalikupin. nauna at ito’y pagmay sa nauna at ito’y pag5. Ipatong ang isa pang 5. Pumosisyon na ang kamay salikupin. salikupin. kamay sa nauna at ito’y ng ay tuwid at kumuha 5. Pumosisyon na ang kamay 5. Pumosisyon na ang kamay pwersa sa iyong balakang, pagsalikupin. ay tuwid at kumuha ng tignan ang pasyente at ay 6.tuwid at kumuha ng Pumosisyon na ang kamay ang pagbomba pwersa sa iyong balakang, pwersaaysimulan sa iyong balakang, tuwid at kumuha ng ng kanyang dibdibang ng pasyente (30) at sa pasyente iyong balakang, tignanpwersa angtignan at tatlongpung ulit napagbomba may simulan ang ng tingnan ang pasyente at simulan ang pagbomba ngbisinusundang ritmo at kanyang dibdib ng (30) simulan ang pagbomba gyan ito ng 2 beses na kanyang dibdib ng (30) tatlongpung ulit na may ng kanyang dibdib ng hangin. ulit na may tatlongpung naritmo 6. tatlumpung U li ti nsinusundang a n(30) g ulit ga nito ng at bisinusundang ritmo at bigyan ito ng 2 proseso ng (5) limang ulit. may sinusundang ritmo atbeses na gyan ito 2 beses na hangin. 7. bigyan Muli ng itong tsekin at obserito ng dalawang (2) 6. naUlitin ga nit ong bahan, tignan ang ulit kung hangin. beses hangin. mayroon itong pulso at proseso ng limang ulit. 6. Uli ti anang g na ga nit(5) o ng 7. nUlitin ganitong proseso hininga, kung meron na,at obser7. Muli itong tsekin ngilagay limang (5) beses. proseso ng (5)sya limang ulit. sa tignan posisyong bahan, ulit kung Muli itong tsekin atobser7. Muli8. itong tsekin atkung komportable, hndi mayroon na itong pulso at obserbahan at tingnan ulit angulit pulsokung at hinbahan, bumalik tignan hininga, kung meron na, kung mayroon na itong inga ulitin lamang ang mayroon nailagay itong sya pulsosaat posisyong proseso hanggang dumatpulso at hininga. Kung hininga, kung meron na, komportable, ing ang tinawag na tulong. meron na, ilagay siya sakung hndi ilagay posisyong sya bumalik sakomportable. posisyong ang pulso at hiningakung ulitin hndi lamang ang komportable, Kung hindi bumalik ang proseso hanggang bumalik ang pulso ulitin at hin- dumatpulso at hininga ing ang tinawag proseso angna tulong. inga lamang ulitin ang lamang hanggang dumating ang proseso hanggang dumattinawag na tulong. ing ang tinawag na tulong.

FOUNDATION OF EMT PRACTICE

FOUNDATION OF EMT PRACTICE BASIC LIFE SUPPORT

CRITICAL CONCEPTS

CRITICAL Moving the VictimCONCEPTS Only Wh Necessary CONCEPTS MovingCRITICAL the Victim Only W DoNecessary not move the victim wh CPRMoving is in progress t the Victimunless Only W victim is in a dangerous en Do not move the victim w Necessary ronment as a unless burni CPR is (such in progress building) ormove if you believe victim in a dangerous Do notis the victim y cannot perform CPR effectiv ronment (such as bur CPR is in progress aunles in the victim's present positi building) or aif dangerous you believe victim is in or cannot location. CPR better ronmentperform (suchisCPR as aeffec bua the victim's po hasin fewer interruptions wh building) or if present you believe or location. CPR is resusc better rescuers perform the cannot perform CPR effec fewer interruptions tionhas they find the victi inwhere the victim's present pow rescuers perform resu or location. CPR the is better tion find the viw has where fewer they interruptions rescuers perform the resu tion where they find the vi

KEY TERMS

 Maneuver— a clever KEY TERMSor skilf action or movement  Maneuver— a clever or s KEY TERMS action or movement  Maneuver— a clever or s action or movement

Mahalagang mapanatilin nakabukas ang daluyan n Mahalagang mapanati hangin habang sinasagaw nakabukas ang daluyan ang iba’t ibang proseso n hangin habangmapanati sinasaga Mahalagang panglunas, upang makatiya ang iba’t ibang proseso nakabukas ang daluyan na ang pasyente ay nakata panglunas, upang sinasag makat hangin habang tanggap ng tamang hangin n na ay nak angang iba’tpasyente ibang proseso kailangan nito. tanggap ng tamang panglunas, upang hangin makat kailangan nito. na ang pasyente ay nak tanggap ng tamang hangin kailangan nito.

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

LIFELINE

DAY UN D UN D

PREHOSPITAL EMERGENCY CARE ¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

Y1 NIT 1 FOUNDATION OF EMT PRACTICE DAY 1 NIT 1 FOUNDATION OF EMT PRACTICE DAY 1Foundational Facts

hen

When hile the When nviwhile ing s the you enviwhile vely rning ss the eion you enviand ctively urning osition hen e you r and citactively when im. osition uscitar and ictim. when uscitaictim.

ful

 The Importance of a Firm Surface

Foundational Facts 

Compressions pump the blood in the heart to the rest of the body. If a Foundational Facts

firm surface is under the victim, the force you use will be more likely to The Importance of a Firm Surface compress the chest and heart and create blood flow rather than simply Compressions pump the bloodCompressions in the heart pump to thethe restblood of the If a to the Foundational Facts • The Importance ofinto a Firm Surface inbody. the heart push the victim the mattress or other soft surface. firm surface is under the victim, the force you use will be more likely tomore restThe of the body. If a firm surface is under the victim, the force you use will be Importance of afor Firm Surface  likely Alternate Technique Chest Compressions compress the chest and heart and create blood flow rather than simply to compress the chest and heart and create blood flow rather than simply push Compressions pump the blood in the heartcompressions, to the rest of the If you have difficulty deeply during putbody. one If a push the victim intopushing the mattress orforce otheryou softuse surface. the victim into the mattress other soft surface. firm surface is under theor victim, the will be more likely to on the breastbone pushCompressions on the chest. Grasp the wrist of that  hand Alternate forto Chest compress Technique the chest and heart and create blood flow rather than simply hand with your other hand to support the first hand as it pushes the If you have difficulty pushing deeply during compressions, one push the victim into the mattress or other soft surface. • Alternate Technique for Chest Compressions. If you have difficultyput pushing deeply chest (Figure 7). This technique is helpful for rescuers with arthritis. hand on the breastbone to push on the chest. Grasp the wrist of that compressions, put for oneChest hand Compressions above the lower half of the sternum to push on during Alternate Technique otherpushing support the first hand pushes thefirst the hand Graspyour the wrist ofhand that to hand withduring your other handastoitsupport the Ifchest. you with have difficulty deeply compressions, put one chest (Figure 7). This technique is helpful for rescuers with arthritis. hand as it pushes the chest. This technique is helpful for rescuers with arthritis. the breastbone to push on the chest. Grasp the wrist of that Openinghand theon Airway for Breaths: Head Tilt-Chin Lift hand with your other hand to support the first hand as it pushes the (Figure This technique is helpful for rescuers arthritis. There are 2chest methods for7). opening the airway to provide breaths:with head tilt-chin lift Opening the Airway for Breaths: Head Tilt-Chin Lift and jaw thrust. Two rescuers are generally needed to perform a jaw thrust and provide with a bag-mask device. This istodiscussed in the "2-Rescuer Adult There breaths are 2 methods for opening the airway provide breaths: head lift There are 2 methods for opening airway to only provide breaths: headatilt-chin tilt-chin Opening the Airway for Breaths: Head Tilt-Chin Lift BLS/Team CPR Sequence" section. Use athe jaw thrust if you suspect headand orlift and jaw thrust. Two rescuers are generally needed to perform a jaw thrust and jaw thrust. Two rescuers are generally needed to perform a jaw thrust and provide neck injury, it may reduce neckdevice. andairway spine movement. Switch to atilt-chin headAdult tiltprovide breaths a bag-mask Thisto is provide discussed in the "2-Rescuer There are 2asmethods for opening the breaths: head lift breaths with a with bag-mask device. This is discussed in the “2-Rescuer Adult BLS/Team chin lift maneuver if the jaw thrust does not open the airway. BLS/Team CPR Sequence" section. Use a jaw thrust only if you suspect a head oras it and jawSequence” thrust. Two rescuers needed to perform a jaw thrust and CPR section. Use aare jawgenerally thrust only if you suspect a head or neck injury, neck injury, as it may reduce neck and spine movement. Switch to a head tiltprovide breaths with bag-mask device.Switch This istodiscussed in thelift "2-Rescuer may reduce neck anda spine movement. a head tiltchin maneuverAdult if the jaw chin lift maneuver ifperform thethe jaw thrust does airway. Follow these steps to a headUse tilt-chin lift : the BLS/Team CPR Sequence" section. a not jawopen thrust only if you suspect a head or thrust does not open airway. neck injury, as it may reduce neck and spine movement. Switch to a head tiltFollow steps iftothe perform a head tilt-chin lift : chin liftthese maneuver jawthe thrust 1. Place one hand on vic- does not open the airway.

Opening the Airway for Breaths: Head Tilt-Chin Lift

Follow these steps to perform a head tilt-chin lift

tim's forehead and push skilful Follow these steps to perform athe head 1. Place onepalm hand the vic- tilt-chin lift : with your toontilt tim'sback. forehead and push head skilful palm on to the tilt victhe 1. with Place your one hand head back. tim's forehead and push with your palm to tilt the head back. 1. Place one hand on the victim’s forehead and push with your palm to tilt the head back. 2. Place the fingers of the other hand under the bony part of 2. Place thejaw fingers the other the lower nearof the chin. hand under the bony part of lower jaw near 2. the Place the fingers of the chin. other ng hand under the bony part of The head-tilt-chinng the lower jaw near the chin. iling lift relieves airway wa obstruction in ngng awa iling an unresponsive 2. Place the fingers of the other ak ng victim. hand under the bony part of the a3. Lift the jaw to bring the chin tiyak gawa Obstruction lower jaw near the chin. na forward. okatang 3. Lift the by jawthe totongue. bring the chin n na tiyak forward. When a victim is katathe chin 3. Lift the unresponsive jaw to bring the n na forward. tongue can block the upper airway. The head-tiltchin-lift maneuver lifts the tongue, relieving airway 3. Lift the jaw to bring the chin Foundation Facts obstruction. forward. The head-tilt-chin-lift relieves airway obstruction in an unresponsive victim. ObFoundation Facts struction by the tongue. Whenairway a victim is unresponsive the tongue can block The head-tilt-chin-lift relieves obstruction in an unresponsive victim. Obthestruction upper airway. The head-tilt-chin-lift maneuver lifts thethe tongue, relieving airFoundation Facts by the tongue. When a victim is unresponsive tongue can block way obstruction. The head-tilt-chin-lift relieves airway obstruction inlifts an unresponsive victim. Obthe upper airway. The head-tilt-chin-lift maneuver the tongue, relieving airstruction by the tongue. When a victim is unresponsive the tongue can block way obstruction. the upper airway. The head-tilt-chin-lift maneuver lifts the tongue, relieving air¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17. way obstruction.

Foundation Facts

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

CRITICAL CONCEPTS Move the victim only when necessary -- Do not move the victim while CPR is in progress unless the victim is in a dangerous environment (such as a burning building) or if you believe you cannot perform CPR effectively in the victim’s present position or location. CPR will be better and will have fewer interruptions when rescuers will perform the resuscitation in the spot where they found the victim.

KEY TERMS � Maneuver — a clever or skilful action or movement

Mahalagang mapanatiling nakabukas ang daluyan ng hangin habang sinasagawa ang iba’t ibang proseso ng panglunas, upang makatiyak na ang pasyente ay nakatatanggap ng tamang hangin na kailangan nito.

LIFELINE

PREHOSPITAL EMERGENCY CARE

bag-mask device, giving breaths. Rescuers should re bag-mask device, whenwhen giving breaths. Rescuers should replace face shields ft with mouth-to-mask or bag-mask devices at the first opportu with mouth-to-mask or bag-mask devices at the first opportunity. Masks usually ress into  deeply Do not press deeply into have a 1-way valve that diverts exhaled air, blood, or have a 1-way valve that diverts exhaled air, blood, or bodily fluids away from bodily ssue the under the soft tissue under the rescuer. rescuer. ause this might chin because this might thethe BASIC LIFE SUPPORT Day 1 CRITICAL CONCE airway. block the airway. se the Dothumb not use theto thumb to Things to Avoid With hin. lift the chin. Chin LiftCRITICAL CONC � close Barrierthe — something ose victim's  the Do not victim's  Do not press Things to Avoid Wit material that blocks or is into the soft t mouth completely. ompletely.

Chin Lift der the chin  this Domight not pres blo into the sof airway. der the chin  Do not use th this might b toairway. lift the chin  Do Donot notclose use mouth comp to lift the ch  Do not clos mouth com

intended to block passage

� Valve — any device for halting or controlling the flow of a liquid, gas, or other material through a passage, pipe, inlet, outlet, etc.

KEY TERMS

ERMS

 Barrier—material something material mething that blocks or is intended to or is intended to ge block passage

FACEMASK FACEMASK FACEMASK

FACE SHIELD FACE SHIELD

FACE SH  Valve—for anyhaltdevice for haltdevice ing or controlling olling the flow the flow Standard precautions include using barrier devices, such as a face mask a liquid, gas, or other gas, ofor other or a bag-mask device, when giving breaths. Rescuers should replace face Foundational Facts Facts material through a passage,Foundational ough a passage, shields with mouth-to-mask or bag-mask devices at the first opportunity. pipe,etc. inlet, outlet, etc. utlet,  Low Low Infection Risk valveRisk usually have a 1-way that diverts exhaled air, blood, or bodily Masks Infection fluids The away from the rescuer. The riskrisk of infection from CPR isfrom extremely low is andextremely limited to a fewlow case and li of infection CPR reports, but the US Occupational Safety and Health Administration reports, but the US Occupational Safety and Health A (OSHA) requires that healthcare use standard precautions in standa (OSHA) requires that workers healthcare workers use the workplace, includingincluding during CPR. during CPR. the workplace,

Adult Mouth-to-Barrier Device Breathing

Giving Adult Mouth-to-Mask Breaths

Foundation GivingFacts Adult Mouth-to-Mask Breaths Giving Adult Mouth-to-Mask Breaths

Ang mga gamit For mouth-to-mask breaths, you use a mask pantulong sa paghinga Sa paggamit ng “ma with or without a one-way valve. The one-way at mahalagang pat lang na panat valve allows the rescuer’s breath to enter the proteksyon pagk victim’s mouth and nose and diverts the victim’s magandang Sa paggamit ng “m mouth-to-mask breaths, you use a mask with or without a 1 -way valve. The ng isang taong laban ForFor mouth-to-mask breaths, you use a mask with or without nito sa pasyente ata Low infection exhaled air away from the rescuer. Some masks pat lang na pana sa mga nakahahawang hin na tama pag a 1 -wayvalve valve allows breath to inlet enter the victim's mouth andthe nose risk -- The risk the rescuer's magandang have an oxygen that allows you administer 1 -way allows the rescuer's breath toto enter victim's m sakit. Ugaliin ang kakaselyado ng bibia of infection from nito sa pasyente supplementary oxygen. Effective use of the mask and diverts the victim's exhaled air away from the rescuer. Some masks have an and diverts the victim's exhaled air away from thenito rescuer. Som paggamit nito. sa na “mask” upan CPR is extremely hinuse tama barrier device requires instructionoxygen. and supervised oxygen inlet that allows you to administer supplementary Effective mga gamit pantulong sa oxygen inlet that allows you to administer supplementary oxy tAng pantulong sa epektibo ang ng pagb kakaselyado bib low and limited to practice. of themask barrier devicedevice requires instruction andinstruction supervised practice. paghinga at mahalagang pro- of the barrier requires andhangin. supervised ahalagang pronito sa “mask” upa amask few case reports, epektibo ang pag teksyon ng isang taong laban but experts require ng taong laban hangin. that healthcare sa mga nakahahawang ahawang sakit. sakit. workers use standard Ugaliin ang paggamit nito. ggamit nito. To usea a mask, mask, the lone rescuer atuse thea mask, victim's side. This victim's position ideal when precautions in the the To lonethe rescuer is at the is victim’s To use lone isrescuer istheat side. This pos workplace, including performing 1 -rescuer CPR because you can give breaths and perform chest com- and side. This position is ideal when performing one-rescuer performing 1 -rescuer CPR because you can give breaths during CPR. canThe givelone breaths and perform chest pressions when positioned atCPR the because victim's side. rescuer holds the mask pressions when positioned atyou the victim's side. The lone rescu compressions when positioned at the victim’s side. The against the victim's face and opens the airway with a head tilt-chin lift. against the victim's face and opens the airway with a head tilt lone rescuer holds the mask against the victim’s face and opens the airway with a head tilt-chin lift.

Giving Mouth-to-Mask Giving Mouth-to-Mask Breaths Giving Mouth-to-Mask BreathsBreaths

LIFELINE

PREHOSPITAL EMERGENCY CARE

DAY 1face shields eplace UNIT 1 unity. Masks usually FOUNDATION y fluids away from DAY 1

OF EMT PRACTICE

Giving Mouth-to-Mask Breaths

EPTS

Follow these steps to open the airway with a head tilt-chin lift and use a mask to give breaths to the victim: Giving Mouth-to-Mask Breaths h Head Tilt1. Position yourself at the victim's side. CEPTS Follow to open the victim's airway with headthe tilt-chin lift of and a mask 2. these Placesteps the mask on the face,ausing bridge theuse nose as a to s deeply give breaths thecorrect victim: guideto for th Head TiltFollow these steps to openposition. the airway with a head tilt-chin lift and use a mask to tissue unPosition yourself at the victim's 3.1. Seal the mask against the face: side. give breaths to the victim: 2. Place the mask on the victim's face, theofbridge of thehead, nose as a because Using the hand that is closer to using the top the victim's place ss deeply guide forindex correct position. ock the your finger and thumb along the edge of the mask. yourself at the victim’s side. ft tissue un- 1. Position 3. Seal the mask against the face: thevictim’s thumbface, of your second handof along the bottom edge of maskPlace on the using the bridge the nose as a guide for correct n because 2. Place the  the Using the hand that is closer to the top of the victim's head, place he thumb mask. position. block the your index finger and thumb thehand edgealong of thethe mask. Placeagainst the remaining of youralong second bony mar3. Seal 1. the mask the face:fingers n.  Place the thumb of your second hand along the bottom edge offingin hand of thethat jawisand lift to thethe jaw. a headhead, tilt-chin lift your to open the closer topPerform of the victim’s place index e the the thumb victim's • Using the the mask.the edge of the mask. airway . ger and thumb along pletely. Place theof remaining ofalong your second hand along thethe bony marhin. 2.1. the While you liftyour the second jaw,fingers press firmly and around outside • Place thumb hand thecompletely bottom edge of the mask. gin of the jaw and lift the jaw. Perform a head tilt-chin lift to open the of thefingers mask to maskhand against thethe face. se the victim's1. Place theedge remaining of seal yourthe second along bony margin of the jaw airway . 3. Deliver air over 1 second to make the victim's chest rise. mpletely. and lift the jaw. Perform a head tilt-chin lift to open the airway . 2. While you lift the jaw, press firmly and completely around the outside 2. While you lift the jaw, press firmly and completely around the outside edge of the edge of the mask to seal the mask against the face. mask to seal the mask against the face. 3. Deliver air over 1 second to make the victim's chest rise.

Giving Mouth-to-Mask Breaths

CRITICAL CONCEPTS There are several things to avoid when doing the head-tilt-chinlift. They are: � Do not press deeply into the soft tissue under the chin because this might block the airway. � Do not use the thumb to lift the chin. � Do not close the victim’s mouth completely.

3. Deliver air over 1 second to make the victim’s chest rise.

HIELD

imited to a few case Administration ard precautions in

ask”, maratilihin ang kakalagay mask”, maraaatilihin 1 -way siguraduang valve. The ang pag- and nose gkakalagay mouth ig at ilong at siguradume masks have an ng maging ang pagygen. bibigay ngEffective use big at ilong d practice. ang maging gbibigay ng

Sa paggamit ng “mask”, marapat lang na panatilihin ang magandang pagkakalagay nito sa pasyente at siguraduhin na tama ang pagkakaselyado ng bibig at ilong nito sa “mask” upang maging epektibo ang pagbibigay ng hangin.

Bag-Mask Device

Bag-Mask Device Bag-mask devices consist of a bag attached to a sition is ideal when face mask. They may perform chest com- also include a 1-way valve. Bag-mask devices are the most method Bag-mask devices consist of a to a Bag-mask devices consist of bag acommon bagattached attached uer holds the mask that healthcare providers use to agive positiveface mask. They may also valve. to a face mask. They may alsoinclude include a 1-way one-way t-chin lift.pressure Bag-mask devices are the most common method ventilation during The bag-mask venvalve. Bag-mask devices areCPR. the most common that healthcare providers use use to give positivetilation technique requires instruction method that healthcare providers toand givepractice pressure duringbyCPR. The bag-mask venand is notventilation recommended a lone rescuer positivepressure ventilation during CPR. Theduring bagtilation technique requires instruction and practice CPR. mask ventilation technique requires instruction and is not recommended by a lone rescuer during and practice and is not recommended by a lone CPR. rescuer during CPR.

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

LIFELINE ¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

PREHOSPITAL EMERGENCY CARE

DAY 1

CRITICAL CONCEPTS

Giving Breaths With SuppleGiving Breaths mentary OxygenIf With you are Supplementary Oxygen- If you using are supplementary oxygen using supplementary oxygen with awith bag-mask device, a bag-mask device, youyou will still deliver deliver eacheach breath over 1 will still breath second. If you use only 1 second over 1 second. If you use only per breath any method 1 second per for breath for ofany delivery, you can help minimize method delivery, you can the of interruptions in chest help minimize compressions the neededinterrupfor breaths and avoid excessive ventilation. tions in chest compressions needed for breaths and avoid excessive KEYventilation. TERMS Positive Pressure Ventilation — The provision of air under pressure by a KEY TERMSrespirator, mechanical a machine designed to improve the exchange Positive Pressure Ventilation— The of air between the lungs provision ofand airthe under pressure atmosphere. Theby a mechanical respirator, a madevice is basically designed chine designed to improve the for administering artificial exchange respiration, of air between the especially for lungs and athe atmosphere. prolonged period, in The device is basically the event ofdesigned inadequate for spontaneous or administering artificial ventilation respiration, respiratory paralysis. especially for a prolonged period, in the event of inadequate spontaneous ventilation or respiratory paralysis. Ang CPR ay nakakapagod na proseso. Ang pagkakaroon ng katuwang sa paggawa nito ay makakabawas ng pagod ninyong Magpalitan sa Ang CPR dalawa. ay nakakapagod na gawain kada matatapos proseso, ang pagkakaroon ng buong CPR. katuwangang sa isang paggawa nito ay makakatipid ng pagod ninyon dalawa. Magpalitan sa Gawain kada matatapos ang isang buong CPR.

Using the Bag-Mask 2-Rescuer CPR BASIC LIFEDuring SUPPORT Day 1

CRITICAL CONCEPTS

Follow these steps to open the airway with a head tilt-chin lift and use a bag-mask Two-rescuer CPR should be to give breaths to the victim: formed with one rescuer 1. Position yourself directly above the victim's head. tioned at the chest area and 2. Follow Placethese the mask onopen thethe victim's bridge the as a steps to airwayface, withusing a headthe tilt-chin liftof and usenose a bag-mask other positioned beside the to giveguide breathsfor to correct the victim: position. tim’s head. The rescuers sh 3. Use the E-C clamp technique to hold the mask in place be while lift thesides of the v on you opposite 1. Position yourself directly above the victim’s head. jaw to hold the airway open: easeforposition 2. Place the mask on the victim’s face, using the bridge of the nose asto a guide correct changes w  Perform a head tilt. one rescuer gets tired. Cha position. should be made  Place the mask on the face with the narrow portion at the bridge of the 3. Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold on cue wit interrupting the rhythm. nose. the airway open: • Perform a head tilt.  Use the thumb and index finger of one hand to make a "C" on the side of UNIT 1 • Place the mask on the face with the narrow portion at the bridge of the the mask, pressing the edges of the mask to the face. DAY 1 nose.  Use the remaining fingers to lift the angles of the jaw (3 fingers form an • Use the thumb and index finger of one hand to make a “C” on the side of "E"), open the airway, and press the face to the mask. the mask, pressing the edges of the mask to the face. 4. • Use Squeeze the bagfingers to givetobreaths (1 second while watching foropen the remaining lift the angles of the each) jaw (3 fingers form an “E”), the airway, press all thebreaths face to the mask. chest rise.and Deliver over 1 second whether or not you use sup4. Squeeze the bag to give breaths (1 second each) while watching for chest rise. Duties Deliver for Each Re plementary oxygen. CONCEPTS all breaths over 1 second whether or not you useCRITICAL supplementary oxygen.

Using the Bag-Mask During Two-Rescuer CPR

FOUN

ln 2-rescuer CPR (Figure Rescuer 1 At the victim's side • Perform chest co - Compress the - Compress at a - Allow the che - Minimize inte chest compressions - Use a compre - Count compr • Switch duties wi taking <5 secon Rescuer 2 At the victim's head • Maintain an ope - Head tilt-chin - Jaw thrust Kahalagahan• Give ng tamang p breaths, wa bukas ng daluyan ng han  Encourage the ay upang hndienough mapunta and f compressions. tiyan and hangin na dapat you will be able to show how to perform 2-rescuer team When a second rescuer is available to help, that  Switch sa response baga. Maaari itongduties mag second rescuer should activate the emergency taking <5 seco lot ng pagsuka ng pasyente Two-rescuer CPR should be performed with one rescuer positioned at the chest area and the other positioned beside the victim’s head. The rescuers should be on opposite sides of the victim to ease position changes when one rescuer gets tired. Changes should be made on cue without interrupting the rhythm.

WRONG

CORRECT

Two-Rescuer Adult BLS/Team CPR Sequence When More Rescuers Arrive LEARNING OBJECTIVES LEARNING 2-Rescuer Adult BLS/Team CPR Sequence

OBJECTIVES

At the end of this section CPR At the end of this system and get the AED. The first rescuer should remain section you will maaring maging sanhi ng p with the victim to start CPR immediately, beginning with be able to show punta nito sa daluyan chest compressions. After the second rescuer returns, the OVERVIEW how to perform rescuers should use the AED as soon as it ishangin. available. 2-rescuer team The rescuers will then give compressions and breaths but ThisCPR section explains how toshould perform 2-rescuer team CPR for adults. switch roles after every 5 cycles of CPR (about every 2 minutes).

When More Rescuers Arrive As additional rescuers arrive, they can help with the

OVERVIEW

LIFELINE

PREHOSPITAL EMERGENCY CARE

Kahalagahan tamang pagbag-mask ventilation, use of theng AED or defibrillator, and bukas ng daluyan ng hangin crash cart. to help, that second rescuer should activate This asection When second rescuer is available ay upang hndi mapunta sa how response system and get the theexplains emergency AED. firstna rescuer should remain tiyan andThe hangin dapat ay to perform with the victim to start CPR immediately,sabeginning with compressions. baga. Maaari itongchest magdu2-rescuer team rescuer returns, the rescuers lot ng pagsuka ngthe pasyente After the second should use AED na as soon as it is CPR forThe adults. maaring maging sanhi ng pagavailable. rescuers will then give compressions and breaths but should switch punta nito sa daluyan ng roles after every 5 cycles of CPR (about every 2 minutes). hangin.

Foundational Fac

As additional rescuers arrive, they can help with the bag-mask ventilation, use ofTeam Performa Effective the AED or defibrillator, and crash cart.

Effective teams commun the rescuer providing b prepare to give them ef

Duties for Each Rescuer

ln 2-rescuer CPR (Figure 12). each rescuer has specific duties: Rescuer 1 At the victim's side •InPerform 2-rescuerchest CPR.compressions. each rescuer has specific duties: - Compress the chest at least 2 inches (5 cm). - Compress at a rate of at least 100/min. Rescuer 1 Allow theside chest to recoil completely after each compression, At -the victim’s - Minimize • Perform chestinterruptions compressions. in compressions (try to limit any interruptions in - chest Compress the chest at least 2-2.5 inches or 5-6 cm. - compressions Compress at a rate of at seconds). least 100-120/min. to <10 - - Use Allow the chest to recoil completelyratio after of each compression, a compressions-to-breaths 30:2. - - Count Minimize interruptions in compressions (try to limit any interruptions in compressions aloud. chest compressions to <10 seconds). • Switch duties with the second rescuer every 5 cycles or about 2 minutes, - Use a compressions-to-breaths ratio of 30:2. taking <5 seconds to switch. - Count compressions aloud. Rescuer 2 • Switch duties with the second rescuer every 5 cycles or about 2 minutes, At the victim's head ; to switch. taking <10 seconds • Maintain an open airway using either - Head Rescuer 2 tilt-chin lift escuer - Jaw thrust At the victim’s head ; • Give breaths, watching for chest rise and avoiding excessive ventilation. • Maintain an open e 12). each rescuer has specific duties: airway using either Head tilt-chin liftfirst rescuer to perform compressions that are deep  - Encourage the - enough Jaw thrust and fast enough and to allow complete chest recoil between ompressions. • Give breaths, watching for chest rise and avoiding excessive ventilation. compressions. e chest at least 2 inches (5 cm). the first rescuer to perform compressions that are deep • Encourage  enough Switch with the rescuer every 5 cycles about 2 minutes, a rate of at least 100/min. andduties fast enough and first to allow complete chest recoil or between est to recoil completely after each taking <5compression, seconds to switch. compressions. erruptions in compressions (try to limit any interruptions in • Switch duties with the first rescuer every 5 cycles or about 2 minutes, s to <10 seconds). taking <5 seconds to switch.

e perposid the e vichould victim when anges thout

Duties for Each Rescuer

NDATION OF EMT PRACTICE

essions-to-breaths ratio of 30:2. ressions aloud. ith the second rescuer every 5 cycles or about 2 minutes, nds to switch.

; en airway using either n lift

pagatching for chest rise and avoiding excessive ventilation. ngin he first rescuer to perform compressions that are deep afastsaenough and to allow complete chest recoil between t. ay with the first rescuer every 5 cycles or about 2 minutes, gduonds e na to switch.

pagng

Foundational Facts Effective Team Performance to Minimize Interruptions in Compressions

CRITICAL CONCEPTS Two-rescuer CPR should be performed with one rescuer positioned at the chest area and the other positioned beside the victim’s head. The rescuers should be on opposite sides of the victim to ease position changes when one rescuer gets tired. Changes should be made on cue without interrupting the rhythm.

Ang kahalagahan ng tamang pagbukas ng daluyan ng hangin ay upang hindi mapunta sa tiyan ang hangin na dapat ay sa baga. Kung sa tiyan mapupunta ang hangin, maaari itong maging sanhi ng pagsusuka ng pasyente, at ang suka ay puwedeng bumara sa daluyan ng hangin.

Effective teams communicate continuously. If the compressor counts out loud, the rescuer providing breaths can anticipate when breaths will be given and prepare to give them efficiently to minimize interruptions in compressions. The count will also help both rescuers to know when the time for a switch is approaching.

Foundational Facts

It is hard work to deliver effective Effective Team Performance to Minimizechest Interruptions in Compressions compressions. If the compressor tires, chest compressions won’t be as Effective teams communicate continuously. If theTocompressor counts out loud, effective. reduce rescuer fatigue, switch the rescuer providing breaths can anticipate whenroles breaths be given compressor everywill 5 cycles (aboutand 2 minutes). To minimize interruptions, The prepare to give them efficiently to minimize interruptions in compressions. perform thethe switch AED is count will also help both rescuers to know when timewhen for athe switch is apanalyzing the rhythm and take no more proaching. than 5 seconds to switch. It is hard work to deliver effective chest compressions. If the compressor tires, chest compressions won't be as effective. To reduce rescuer fatigue, switch compressor roles every 5 cycles (about 2 minutes). To minimize interruptions, perform cts the switch when the AED is analyzing the rhythm and take no more than 5 secance to Minimize Interruptions in Compressions onds to switch.

nicate continuously. If the compressor counts out loud, breaths can anticipate when breaths will be given and ¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17. fficiently to minimize interruptions in compressions. The

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mask ventilation than 1 rescuer. When 2 rescuers use the bag-ma

theand airway withsuspect a head tilt-chin lift (orinjury, jaw thrust) If the victim has a head orrescuer neck opens injury you a spine 2 mask to the face while the other rescuer squeezes the bag (Figure may use another method to open theshould airway: jawthethrust Two people sional rescuers learnaboth 1 - and .2-rescuer bag-maskpe v niques. When the course, practice with devices for both jaw thrust while holding the neck stillpossible and ingiving bag-mask ventilation. If BASIC LIFEmouth-to-mask SUPPORT ventilation. Day 1 thrust does not open the airway, use a head tilt-chin lift.

2 Rescuers Using the Bag-Mask

Follow these When steps perform jawthe thrust: 3 orto more rescuers areapresent, 2 rescuers can provide more effective Opening Airway for Breaths: bagmask ventilation than 1 rescuer. When 2 rescuers use the head, bag-maskresting system, oneyour elbows 1. Place one hand on each side of the victim's rescuer opens the airway with a head tilt-chin lift (or jaw thrust) and holds the mask surface onfacewhich is lying. Jaw to the while thethe othervictim rescuerThrust squeezes the bag. All professional rescuers should both the 1 - and 2-rescuerthe bag-mask ventilation techniques. Whenlower possible in the and lift w 2. Place learn your fingers under angles of the victim's jaw course, practice with devices for both bag-mask and mouth-to-mask ventilation. the victim a head or neck injury and you suspect a spine inju both hands, displacingIf the jaw has forward. may use another method to open the airway: a jaw thrust . Two peo 3. If the lips close, push the lip holding with your thumb open the lips. jaw lower thrust while the neck still andto giving bag-mask ventila thrust does the airway, use a head tilt-chin lift. Opening the Airway fornot open Breaths:

Follow these steps to perform a jaw thrust: 1. Place one hand on each side of the victim's head, resting your e surface on which the victim is lying. 2. Place your fingers under the angles of the victim's lower jaw an both hands, displacing the jaw forward. 3. If the lips close, push the lower lip with your thumb to open the

ust” ay mahirap g pagbukas ng hangin, nanganAng “ jaw thrust” ay mahirap na ng ibayongisang pagparaan ng pagbubukas Ang “Jaw Thrust” ay mahirap gat. Ito ayngginadaluyan ng hangin. na paraan ng pagbukas ng Nangangailangan ito ng enteng maaaring daluyan ng hangin, nanganJaw Thrust ibayong pagsasanaygailangan at ito ng ibayong pagg “spine:”ingat.na If the victim has a head or neck injury and you suspect a spine injury, 2 rescuers Ito ay ginagawa sasanay at ingat. Ito ay ginamay use another method to open the airway: a jaw thrust . Two people perform a jaw sa pasyenteng maaaring dulot ng seryosgawa sa pasyenteng maaaring thrust while holding the neck still and giving bag-mask ventilation. If the jaw thrust napinsala ang “spine” nadamay ang “spine:” n. does not open the na airway, use a head tilt-chin lift. at posibleng nagkaroon maaring magdulot ng seryosng seryosong kondisyon. ong kondisyon. Follow these steps to perform a jaw thrust:

1. Place one hand on each side of the victim’s head, resting your elbows on the surface on which the victim is lying. 2. Place your fingers under the angles of the victim’s lower jaw and lift with both hands, displacing the jaw forward. 3. If the lips close, push the lower lip with your thumb to open the lips. ¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

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¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

ask system, one and holds the rescuers 13). All profeserform a ventilation techh the bag-mask jawand

AUTOMATED EXTERNAL DEFIBRILLATOR FOR ADULTS AND CHILDREN 8 YEARS OF AGE s on the AND OLDER with OVERVIEW LEARNING OBJECTIVES ury, 2 rescuers

ople perform At a the end of this section you will be able to ation. If the jaw • List the steps common to the operation of all AEDs • Show proper placement of the AED pads • Recall when to press the SHOCK elbows on the button when using an AED • Explain why no one should touch the victim when prompted by the AED nd lift with during analysis and shock delivery • Describe the proper actions to take e lips. when the AED gives a “no shock indicated” (or “no shock advised’’) message • Show coordination of CPR and AED use to minimize • Interruptions in chest compressions • Time between last compression and shock delivery • Time between shock delivery and resumption of chest compressions

This interval from collapse to defibrillation is one of the most important determinants of survival from sudden cardiac arrest with ventricular fibrillation (see Foundational Facts or pulseless ventricular tachycardia. Automated external defibrillators (AEDs| are computerized devices that can identify cardiac rhythms that need a shock, and they can then deliver the shock. AEDs are simple to operate, allowing laypersons and healthcare providers to attempt defibrillation safely.

CRITICAL CONCEPTS If multiple rescuers are present, one rescuer should continue chest compressions while another rescuer attaches the AED pads. AEDs are available in different models with a few differences from model to model, but all AEDs operate in basically trie same way. To reduce the time to shock delivery, you should ideally be able to perform the first 2 steps within 30 seconds after the AED arrives at the victims side. AED Arrival Once the AED arrives, place it at the victim’s side, next to the rescuer who will operate it. This position provides ready access to the AED controls and easy placement of AED pads. It also allows a second rescuer to perform CPR from the opposite side of the victim without interfering with AED operation.

There are 4 universal steps for operating an AED: 1. POWER ON the AED (the AED will then guide you through the next steps). • Open the carrying case or the top of the AED. • Turn the power on (some devices will “power on” automatically when you open the lid or case). 2. ATTACH AED pads to the victim’s bare chest. • Choose adult pads (not child pads or a child system) for victims S years of age and older. • Peel the backing away from the AED pads. • Attach the adhesive AED pads to the victim’s bare chest. -Place one AED pad on the victim’s upper-right chest (directly below the collarbone). -Place the other pad to the side of the left nipple, with the top edge of the pad a few inches below the armpit. • Attach the AED connecting cables to the AED box (some are preconnected). 3. “Clear” the victim and ANALYZE the rhythm, • If the AED prompts you, clear the victim during analysis. Be sure no one is touching the victim, not even the rescuer in charge of giving breaths. • Some AEDs will tell you to push a button to allow the AED to begin analyzing the heart rhythm; others will do that automatically. The AED may take about 5 to 15 seconds to analyze. • The AED then tells you if a shock is needed. LIFELINE

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aneous circulation, or ROSC).

sions.

Foundational Facts CRITICAL CONCEPTS

LIFE Time SUPPORT Day 1 of BASIC Importance Minimizing Between Last Compression and Shock Delivery 4. If the AED advises a shock, it will tell you to clear the victim.

Analysis• of thousands of rhythm strips recorded after Clear the victim before delivering the shock: be surebefore no one isand touching theshock victim. delivery Defibrillation has shown that if rescuers can keep the time between the last compression and • Loudly state a “clear the victim” message, such as “Everybody clear” or simply “Clear.” When ventricular fibrillation shock delivery to 10 seconds or less, the shock is much more likely to be effective • Look to be sure no one fibrillation is in contact with victim.in return of spontaneous circula(ie, to eliminate ventricular andtheresult is present, trie heart muscle • Press the SHOCK button. fibers quiver and do not contract tion). • The shock will produce a sudden contraction of the victim’s muscles.

together to pump blood. A defibrillator delivers an electric shock to stop the quivering of the heart fibers. This allows the muscle fibers of the heart to “reset” so that they can begin to contract at the same time. Once an organized rhythm occurs, the ng heartkuryente muscle may begin pagbibigay na to contract effectively and begin to yon sa kondisyon ng generate a pulse (called return yente, siguraduhin ang or of spontaneousna circulation, a kasama ROSC). ay hndi nakadikit

5. If no shock needed,delivery and after any shock delivery, immediately for resume CPR, additional startEffectiveness of isshock decreases significantly every 10 ing with chest compressions. seconds that elapses between last compression and shock delivery. Minimizing this interval 6. After 5will cyclesrequire or about 2practice minutes ofand CPR. excellent the AED willteam promptcoordination, you to repeat stepsparticularly 3 between the and 4. compressor and the rescuer operating the defibrillator.

NOTE:

If the AED flashes “No shock advised,” immediately restart CPR beginning with chest compressions.

o, walang metal na nakat o dikit sa pasyente at higit lahat, ipaalam sa kasama g ikay magbibigay na ng Sa pagbibigay ng ock”. Itaas ang dalawang kuryente na naayon sa may habang kondisyon sinasabing pasyente, ang ang “CLEAR” siguraduhin na ang mga kasamahan mo ay hindi nakadikit dito at walang metal na nakasuot o nakadikit sa pasyente. At higit sa lahat, ipaalam sa kasamahan kung ikaw ay magbibigay na ng “shock.” Itaas ang dalawang kamay habang hawak ang AED pads at sinasabi ang salitang “Clear!”

Foundational Facts Why is it important to minimize the time between the last compression and shock delivery? of thousands of rhythm stripsStudent recorded before and 6-17. after shock ¹ American HeartAnalysis Association. “BLS for Healthcare Providers”, Manual (2010):

delivery has shown that if rescuers can keep the time between the last compression and shock delivery to 10 seconds or less, the shock is much more likely to be effective (ie, to eliminate ventricular fibrillation and result in return of spontaneous circulation). Effectiveness of shock delivery decreases significantly for every additional 10 seconds that elapses between last compression and shock delivery. Minimizing this interval will require practice and excellent team coordination, particularly between the compressor and the rescuer operating the defibrillator.

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Special Situations The following special situations may require the rescuer to take additional actions when using an AED: • • • •

The victim has a hairy chest. The victim is immersed in water or water is covering the victim’s chest. The victim has an implanted defibrillator or pacemaker. The victim has a transdermal medication patch or other object on the surface of the skin where the AED pads are placed.

Hairy Chest If a teen or adult victim has a lot of chest hair, the AED pads may not properly stick to the skin on the chest. If this occurs, the AED will not be able to analyze the victim’s heart rhythm. The AED will then give a “check electrodes” or “check electrode pads” message. 1. If the pads stick to the hair instead of the skin, press down firmly on each pad. 2. If the AED continues to prompt you to “check pads” or “check electrodes,” quickly pull off the pads. This will remove a large amount of hair and should allow the pads to stick to the skin. 3. If a large amount of hair still remains where you will put the pads, shave the area with the razor in the AED carrying case. 4. Put on a new set of pads. Follow the AED voice prompts.

Implanted Defibrillators and Pacemakers

Water Water is a good conductor of electricity. Do not use an AED in water. If the victim is in water, pull the victim out of the water. If the victim is lying in water or the chest is covered with water, the water may conduct the shock electricity across the skin of the victim’s chest. This prevents the delivery of an adequate shock dose to the heart. If water is covering the victim’s chest, quickly wipe the chest before attaching the AED pads. If the victim is lying on snow or in a small puddle, you may use the AED.

Victims with a high risk for sudden cardiac arrest may have implanted defibrillators/ pacemakers that automatically deliver shocks directly to the heart. You can immediately identify these devices because they create a hard lump beneath the skin of the upper chest or abdomen. The lump is half the size of a deck of cards, with an overlying scar. If you place an AED pad directly over an implanted medical device, the device may block delivery of the shock to the heart. Occasionally the analysis and shock cycles of implanted defibrillators and AEDs will conflict. If the implanted defibrillator is delivering shocks to the victim (the victim’s muscles contract in a manner like that observed after an AED shock), allow 30 to 60 seconds for the implanted defibrillator to complete the treatment cycle before delivering a shock from the AED.

Huwag gamitin ang AED kung ang biktima ay basa o nasa tubig. Siguruhing tuyo ang buong katawan ng biktima lalo na ang dibdib nito bago gamitin ang AED.

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Day 1

BASIC LIFE SUPPORT

CRITICAL CONCEPTS You may leave an AED attached while transporting the victim on a stretcher or in an ambulance. Never push the ANALYZE button while moving the victim. Because movement can interfere with rhythm analysis and artifacts can simulate ventricular fibrillation, the rescuer must bring the stretcher or vehicle to a complete stop and then reanalyze.

Transdermal Medication Patches Do not place AED pads directly on top of a medication patch (eg, a patch of nitroglycerin, nicotine, pain medication, hormone replacement therapy, or antihypertensive medication). The medication patch may block the transfer of energy from the AED pad to the heart and may cause small burns to the skin. If it won’t delay shock delivery, remove the patch and wipe the area clean before attaching the AED pad.

Two-Rescuer BLS Sequence with an AED Follow these BLS steps for 2 rescuers with an AED: 1. Check for response and check breathing: If the victim does not respond and is not breathing or not breathing normally (ie, only gasping): • The first rescuer stays with the victim and performs the next steps until the second rescuer returns with the AED. • The second rescuer activates the emergency response system and gets the AED. 2. Check for pulse: If a pulse is not definitely felt in 10 seconds: • The first rescuer removes or moves clothing covering the victim’s chest (this will allow rescuers to apply the AED pads when the AED arrives). • The first rescuer starts CPR, beginning with chest compressions. 3. Attempt defibrillation with the AED: • When the AED arrives, place it at the victim’s side near the rescuer who will be operating it. The AED is usually placed on the side of the victim opposite the rescuer who is performing chest compressions . 4. POWER ON the AED (the AED will then guide you through the next steps) (Figure 17). • Open the carrying case or the top of the AED. • Turn the power on (some devices will “power on” automatically when you open the lid or case). 5. ATTACH AED pads to the victim’s bare chest . • Choose adult pads (not child pads or a child system) for victims 8 years of age and older. • Peel the backing away from the AED pads. • Attach the adhesive AED pads to the victim’s bare chest. - Place one AED pad on the victim’s upper-

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right chest (directly below the collarbone). - Place the other pad to the side of the left nipple, with the top edge of the pad a few inches belowthe armpit. • Attach the AED connecting cables to the AED box (some are pre-connected). 6. “Clear” the victim and ANALYZE the rhythm. • If the AED prompts you, clear the victim during analysis. Be sure no one is touching the victim, not even the rescuer in charge of giving breaths. • Some AEDs will tell you to push a button to allow the AED to begin analyzing the heart rhythm; others will do that automatically. The AED may take about 5 to 15 seconds to analyze. • The AED then tells you if a shock is needed. 7. If the AED advises a shock, it will tell you to clear the victim. • Clear the victim before delivering the shock (Figure 20A): be sure no one is touching the victim. • Loudly state a “clear the victim” message, such as “Everybody clear” or simply “Clear.” • Look to be sure no one is in contact with the victim. • Press the SHOCK button. • The shock will produce a sudden contraction of the victim’s muscles. 8. If no shock is needed, and after any shock delivery, immediately resume CPR, starting with chest compressions. 9. After 5 cycles or about 2 minutes of CPR, the AED will prompt you to repeat steps 6 and 7. If “no shock advised,” immediately restart CPR beginning with chest compressions.

BLS for Healthcare Providers Course One- and Two-Rescuer Adult BLS With AED Skills Testing Criteria and Descriptors 1. Assesses victim (Steps 1 and 2, assessment and activation, must be completed within 10 seconds of arrival at scene): • Checks for unresponsiveness (this MUST precede starting compressions) 2. Activates emergency response system (Steps 1 and 2, assessment and activation, must be completed within 10 seconds of arrival at scene): • Shouts for help/directs someone to call for help AND get AED/ defibrillator 3. Checks for pulse and breathing. • Checks carotid pulse • This should take no more than 10 seconds 4. Delivers high-quality CPR (initiates compressions within 10 seconds of identifying cardiac arrest): • Correct placement of hands/fingers in center of chest - Adult: Lower half of breastbone - Adult: 2-handed (second hand on top of the first or grasping the wrist of the first hand) • Compression rate of at least 100 to 120 per minute. - Delivers 30 compressions in 18 seconds or less • Adequate depth for age • Adult: at least 2 inches (5 cm) • Complete chest recoil after each compression • Minimizes interruptions in compressions: - Less than 10 seconds between last compression of one cycle and first compression of next cycle - Compressions not interrupted until AED analyzing rhythm - Compressions resumed immediately after shock/no shock indicated

5-8. Integrates prompt and proper use of AED with CPR: • Turns AED on • Places proper-sized pads for victim’s age in correct location • Clears rescuers from victim for AED to analyze rhythm (pushes ANALYZE burton if required by device) • Clears victim and delivers shock • Resumes chest compressions immediately after shock delivery • Does NOT turn off AED during CPR • Provides safe environment for rescuers during AED shock delivery: - Communicates clearly to all other rescuers to stop touching victim - Delivers shock to victim after all rescuers are clear of victim • Switches during analysis phase of AED 9. Provides effective breaths: • • • •

Opens airway adequately Delivers each breath over 1 second Delivers breaths that produce visible chest rise Avoids excessive ventilation

Sapat ang hangin na ibinubuga mo kung tumataas ang dibdib ng pasyente pagka-ihip mo sa bibig nito.

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Day 1

BASIC LIFE SUPPORT

BLS/CPR for Children from One Year of Age to Puberty LEARNING OBJECTIVES At the end of this section you will be able to tell the basic steps of CPR for children.

OVERVIEW This section covers the basic steps of CPR for children from 1 year of age to puberty. Signs of puberty include chest or underarm hair on males and any breast development in females.

CRITICAL CONCEPTS Many infants and children are thought to develop respiratory arrest and bradycardia before they develop cardiac arrest. If such children receive prompt CPR before development of cardiac arrest, they have a high survival rate.

Child BLS The child BLS sequence and skills are similar to the sequence for adult BLS. The key differences between child and adult BLS are • Compression-ventilation ratio for 2-rescuer CPR: 15:2 ratio for 2-rescuer child CPR • Compression depth; For children, compress at least one third the depth of the chest, approximately 2 inches (5 cm) • Compression technique: May use 1- or 2-handed chest compressions for very small children • When to activate the emergency response system: - If you did not witness the arrest and are alone, provide 2 minutes of CPR before leaving the child to activate the emergency response system and get the AED (or defibrillator). - If the arrest is sudden and witnessed, leave the child to activate the emergency response system and get the AED (or defibrillator), and then return to the child.

Compression Rate and Ratio for Lone Rescuer The lone rescuer should use the universal compression-ventilation ratio of 30 compressions to 2 breaths when giving CPR to victims of all ages (except newly born infants). The term universal represents a consistent recommended ratio for all lone rescuers for victims of all ages.

One-Handed Chest Compressions For very small children you may use either t or 2 hands for chest compressions. Make sure you compress the chest one third the depth of the chest with each compression.

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PREHOSPITAL EMERGENCY CARE

One-Rescuer Child CPR Follow these steps to perform the 1 -rescuer BLS sequence for a child: 1. Check the child for a response and check breathing. If there is no response and no breathing or only gasping, shout for help. 2. If someone responds, send that person to activate the emergency response system and get the AED. If the child collapsed suddenly and you are alone, leave the child to activate the emergency response system and get the AED; then return to the child. 3. Check the child’s pulse (take at least 5 but no more than 10 seconds). You may try to feel the child’s carotid or femoral pulse. 4. If within 10 seconds you don’t definitely feel a pulse or if, despite adequate oxygenation and ventilation, the heart rate is <60/min with signs of poor perfusion, perform cycles of compressions and breaths (30:2 ratio), starting with compressions. 5. After 5 cycles, if someone has not already done so, activate the emergency response system and get the AED (or defibrillator). Use the AED as soon as it is available.

Locating the Femoral Artery Pulse To perform a pulse check in the child, palpate a carotid or femoral pulse. If you do not definitely feel a pulse within 10 seconds, start chest compressions. Follow these steps to locate the femoral artery pulse: 1. Place 2 fingers in the inner thigh, midway between the hipbone and the pubic bone and just below the crease where the leg meets the abdomen. 2. Feel for a pulse for at least 5 but no more than 10 seconds. If you do not definitely feel a pulse, begin CPR, starting with chest compressions (C-A-B sequence).

Foundational Facts When to Activate the Emergency Response System If the rescuer leaves a child with respiratory arrest or bradycardia to phone the emergency response system. The child may progress to cardiac arrest, and the chance of survival will be much lower. For this reason, if the lone rescuer finds an unresponsive child who is not breathing or only gasping, the rescuer should provide 5 cycles (about 2 minutes] of CPR before activating the emergency response system. Compression Depth, Adult vs Child Recommended depth of compressions: • Adults: AT LEAST 2 inches • Children: At least one third of the anterior-posterior depth of the chest or APPROXIMATELY 2 inches (5 cm)

Kung ang bata ay hindi humihinga, bigyan muna ito ng CPR bago tumawag sa telepono at humingi ng tulong.

2-Rescuer Child BLS Sequence Follow these steps to perform the 2-rescuer BLS sequence for a child (no AED): 1. Check the child for a response and check breathing. If there is no response and no breathing or only gasping, the second rescuer activates the emergency response system 2. Check the child’s pulse (take at least 5 but no more than 10 seconds). You may try to feel the child’s carotid or femoral pulse. 3. If within 10 seconds you don’t definitely feel a pulse or if, despite adequate oxygenation and ventilation, the heart rate is <60/min with signs of poor perfusion, perform cycles of compressions and breaths (30:2 ratio). When the second rescuer arrives, use a compressions-to-breaths ratio of 15:2. LIFELINE

PREHOSPITAL EMERGENCY CARE

Day 1

BASIC LIFE SUPPORT

CRITICAL CONCEPTS Use barrier devices in the same manner as for adults.

Child Ventilation With Barrier Devices To provide bag-mask ventilation, select a bag and mask of appropriate size. The mask must be able to cover the victim’s mouth and nose completely without covering the eyes or overlapping the chin. Once you select the bag and mask, perform a head tilt-chin lift to open the victim’s airway. Press the mask to the child’s face as you lift the child’s jaw, making a seal between the child’s face and the mask. Connect supplementary oxygen to the mask when available.

Why Breaths Are Important for Infants and Children in Cardiac Arrest

CRITICAL

For the purpo sequence desc diatric BLS Algo infant means in of age (12 mo newly born infa ery room. For 1 year and old for Children F Age to Puberty

When sudden cardiac arrest occurs (ie, typical cardiac arrest in an adult), the oxygen content of the blood is typically normal, so compressions alone may maintain adequate oxygen delivery to the heart and brain for the first few minutes after arrest.

Ang mahusay na CPR ay nagbibigay ng tsansa sa pasyente na mabuhay. Mahusay ang CPR kung nagawa ito nang maaga, tama ang lalim ng pagdiin, tuluy-tuloy ito at sinusundan ng tamang buga ng hangin sa bibig na nagpapataas sa dibdib ng pasyente.

In contrast, infants and children who develop cardiac arrest often have respiratory failure or shock that reduces the oxygen content in the blood even before the onset of arrest. As a result, for most infants and children in cardiac arrest, chest compressions alone are not as effective for delivering oxygen to the heart and brain as the combination of compressions plus breaths. For this reason, it is very important to give both compressions and breaths for infants and children during CPR. High-quality CPR improves a victim’s chances of survival. The critical characteristics of highquality CPR in adults include • Start compressions within 10 seconds of recognition of cardiac arrest. • Push hard, push fast: Compress at a rate of at least 100-120/min with a depth of at least 2-2.5 inches or 5-6 cm for adults, approximately 2 inches (5 cm) for children, and approximately 1½ inches (4 cm) for infants. • Allow complete chest recoil after each compression. • Minimize interruptions in compressions (try to limit interruptions to less than 10 seconds). • Give effective breaths that make the chest rise. • Avoid excessive ventilation.

LIFELINE

PREHOSPITAL EMERGENCY CARE

Ang pulso n naipanganak isand taon ay m kanilang braso

UNIT 1 DAY 1

L CONCEPTS

FOUNDATION OF EMT PRACTICE

BLS/CPR for Infants

Infant BLS

LEARNING OBJECTIVES oses of the BLS cribed in the Pethe end this section able to infant BLS of sequence and you skillswill arebevery orithm, the termThe At similar to those used for child and adult CPR. The key  Tell the basic steps of CPR for infants nfants to 1 year differences for infant BLS are  Show the basic steps of CPR for infants onths), excluding ants in the deliv• TheOVERVIEW location of pulse check: brachial artery in BLS for children At the end of this section der, see "BLS/CPR infants • Technique of delivering compressions: 2 fingers This section covers the basic steps of CPR for infants. you will be able to From 1 Year of for single rescuer and 2 thumb-encircling hands y." technique for 2 rescuers • Tell the basic steps Infant BLS • Compression depth: at least one third the chest of CPR for infants depth, approximately 1.5 inches (4 cm) • Show the basic The infant BLS sequence and skills arefor very similar to those used forofchild • Compression-ventilation rate and ratio 2 rescusteps CPRand for adult CPR. The key differences for infant BLS are ers: same as for chiJd—15:2 ratio for 2 rescuers infants • When to activate the emergency response system location of pulse check: brachial artery in infants (same asforThe child):  Technique of delivering • If you did not witness the arrest andcompressions: are alone, 2 fingers for single rescuer and 2 thumb-encircling hands technique for 2 rescuers provide 2 minutes of CPR before leaving the infant  the Compression at least oneand third to activate emergencydepth: response system getthe chest depth, approximately inches (4 cm) the AED (orVh defibrillator).  Compression-ventilation andthe ratio • If the arrest is sudden and witnessed,rate leave in-for 2 rescuers: same as for chiJd—15:2 ratio rescuers This section covers fant to phone 16-911 and getfor the2AED (or defibrilthe(same basic as steps lator), then to activate the infant.  return When to the emergency response system for of child): CPRprovide for infants.  If you did not witness the arrest and are alone, 2 minutes

LEARNING OBJECTIVES

CRITICAL CONCEPTS For the purposes of the BLS sequence described in the Pediatric BLS Algorithm, the term infant means infants to 1 year of age (12 months), excluding newly born infants in the delivery room. For BLS for children 1 year and older, see “BLS/CPR for Children From 1 Year of Age to Puberty.”

OVERVIEW

Ang pulso ng mga batang naipanganak palang at edad isand taon ay mas nakakapa sa kanilang braso.

of CPR before leaving the infant to activate the emergency reLocating the Brachial Artery Pulse sponse system and get the AED (or defibrillator).

If the arrest is sudden and witnessed, leave the infant to phone 911 To perform a  pulse check in an infant, palpate a and get the AED (or defibrillator), then return to the infant. brachial pulse. It can be difficult for healthcare providers to determine the presence or absenceArtery of a pulsePulse in any Locating the Brachial victim, but it can be particularly difficult in an infant. perform a pulse check in not an infant, palpate a brachial pulse. It can be difficult If anTo infant is unresponsive and breathing for healthcare to determine presence or absence of a pulse in any or only gasping and youproviders do not definitely feel athe pulse victim, but it can be particularly difficult in an infant. within 10 seconds, start CPR. It is important that you begin chest compressions if you do not feel a or only gasping and you do not If an infant is unresponsive anddefinitely not breathing pulse within 10 secondsdefinitely feel a pulse within 10 seconds, start CPR. It is important that you begin

chest compressions if you do not definitely feel a pulse within 10 secondsng mga batang palang at edad Follow Follow to locate brachialartery arterypulse: pulse: thesethese stepssteps to locate thethebrachial mas nakakapa sa o. 2 oron3 the fingers on of thethe 1. Place 21.or 3Place fingers inside of the arm. upper arm.inside between theupper infant’s elbow between the infant's eland shoulder. bow and shoulder. 2. Press the middle index and mid2. Press the index and fingers dle fingers gently on gently on the inside of the upperthe arm of the upper arm for for at least inside 5 but no more than 70 secat least 5 but no more onds whenthan attempting to feel the pulse. 70 seconds when attempting to feel the pulse.

LIFELINE

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

PREHOSPITAL EMERGENCY CARE

UNIT 1 BASIC LIFE SUPPORT Day 1 FOUNDATION DAY 1

OF EMT PRACTICE

U U D D

Compression Depth In Infants

ln infants, the recommended compression depth is at least one third ofPARAAN the anteriorNG CPR: PARAAN NG CPR: PARAAN NG CPR: Compression Depth In InfantsVh inches (4 cm). This PARAAN NGang CPR:estado n posterior depth of the infant’s chest, or approximately is Tsekin different 1. 1. Tsekin ang estado n 1. Tsekin ang estado n 1. Tsekin ang estado n from compression depth for both adults (at least 2 inches) and children (at least malayan one ng pas malayan ng pas malayan ng pas malayan ng pas third the depthlnofinfants, the chest, inches [5 cm]).depth is at least onetapikin the approximately recommended2 compression third of the anteng dalawan tapikin ng tapikin ng dalawan dalawan tapikin ng dalawan rior-posterior depth of the infant's chest, or approximately Vh inches (4 cm). This ses and parehong ses and parehong ses and parehong ses and parehong is different from compression depth for both adults (at least 2 inches) and chilpakan o kamay pakan o kamay dren (at least one third the depth of the chest, approximately 2pakan inches [5 o cm]).kamay pakan o kamay pasyente. Tumawa pasyente. Tumawa pasyente. Tumawa Compression Rate and Ratio for Lone Rescuer The lone rescuer should use the pasyente. Tumawa tulong. tulong. tulong. universal compression-ventilation ratio of 30 compressions to 2 breaths when giving tulong. 1-Rescuer Infant CPR 2. Kapain ang pulso sa 2. Kapain ang sa CPR to victims of all ages. The term universal represents an attempt to develop a 2. Kapain ang pulso sa 2. dang Kapainbraso ang pulso pulso sa ng pas dang braso ng pas consistent ratioCompression for lone rescuers. dang braso ng pas dang braso ng pas Rate and Ratio for Lone Rescuer habang pinakikira habang pinakikira habang pinakikira The lone rescuer should use the universal compression-ventilation ratio of 30 habang pinakikira m a n a n g kk a n m a n a n g m a n a n g a n compressions to 2 breaths when giving CPR to victims of all ages. The term uni- k Follow these steps to perform 1-rescuer BLS for an infant: m a n a n g ka an n paghinga, obserb paghinga, obserb paghinga, obserb versal represents an attempt to develop a consistent ratio for lone rescuers. paghinga, obserb ang dibdib kung ang kung ang dibdib kung 1. Check the infant for a response and check breathing. If there is no response and dibdib ang dibdib kung umaangat o hindi. umaangat o hindi. Follow these steps to perform 1-rescuer BLS for an infant: no breathing or only gasping, shout for help. umaangat o hindi. umaangat o hindi. 3. Kung sa iyong p 3. iyong p 2. If someone responds, send that person to activate the emergency response sys- sa 3. Kung sa iyong p 3. Kung Kung sawala iyong p serba ay itong 1. AED Check infant for a response and check breathing. serba If there is no reay wala itong tem and get the (orthe defibrillator). serba ay wala itong serba ay wala itong at hiniga, ilagay ang and no breathing or5only gasping, shout help. 3. Check the infant’ssponse brachial pulse (take at least but no more than 10for seconds). at hiniga, ilagay ang at hiniga, ilagay ang at hiniga, ilagay ang 2. If someone responds, send that person to activate the emergency rewang daliri sa gitn 4. If there is no pulse or if. despite adequate oxygenation and ventilation, thewang heart daliri sa gitn Hindi na kailangan wang daliri sa gitn wang daliri sa gitn sponse system and get the AED (or defibrillator). dibdib, simulan ang rate is <60/min with signs of poor perfusion, perform cycles of compressions and simulan dibdib, ang itingalang mabuti ang dibdib, simulan ang dibdib, simulan ang Check the infant's brachial pulse (take at least 5 but nobomba more than 10 ng kanyang breaths (30:23.ratio), starting with compressions. mga kapapanganak bomba ng kanyang bomba ng bomba ng kanyang kanyang seconds). 5. After 5 cycles, if someone has not already done so. activate the emergency redib ng (30) tatlong palang, hndi pa dib ng (30) tatlong dib ng (30) tatlong dib ng (30) tatlong 4. If there is no pulse or if. despite adequate oxygenation and ventilation, sponse system and get the AED (or defibrillator). ulit na may sinusun gaanong ulit na may sinusun ulit na may sinusun ulit na may sinusun the heart rate is &lt;60/min with signs of poor perfusion, perform cycles ritmo at bigyan ito debelop ang kanilang at bigyan ritmo at bigyan ito of compressions and breaths (30:2 ratio), starting withritmo compressions. ritmo at hangin. bigyan ito ito leeg at daluyan ng beses na beses na hangin. beses na hangin. 5. After 5 cycles, if someone has not already done so. activate the emerbeses na hangin. hangin, at 4. Ulitin ang gan 4. ang gan 4. Ulitin ang gan gency response system and get the AED (or defibrillator). DEMONSTRATION 4. Ulitin Ulitin ang gan masyado malaki NOTE: proseso ng (5) liman proseso ng (5) liman proseso ng (5) liman ON NEXT PAGE. proseso ng (5) liman at mabigat ang 5. Muli itong tsekin at 5. itong tsekin at NOTE: DEMONSTRATION ON NEXT PAGE. 5. Muli itong tsekin at 5. Muli Muli itong tsekinulit at kanilang ulo kaya sa bahan, tignan bahan, tignan ulit bahan, tignan ulit bahan, tignan ulit pagtingala mayroon na itong pu mayroon na pu mayroon na itong pu 2-Finger Chest Compression Technique mayroon na itong itong pu nito lalo lamang hininga, kung mero hininga, kung mero hininga, kung mero naisasara ang hininga, kung mero ilagay sya sa posi ilagay sya posi sya sa posi daluyan ng hangin. ilagay sya sa sa kung posi give chest compressions the 2 finger Follow theseFollow steps these to givesteps chestto compressions to an infantto an infant usingilagay komportable, komportable, kung komportable, kung komportable, kung technique: using the 2 finger technique: bumalik ang pulso a bumalik ang pulso bumalik ang pulso a bumalik ang lamang pulso a a inga ulitin inga ulitin lamang inga ulitin lamang 1. onPlace infant on a inga ulitin lamang 1. Place the infant a firmthe surface. proseso hanggang proseso hanggang proseso hanggang firmcentre surface. proseso hanggang 2. Place 2 fingers in the of the infant’s mating ang tinawa Hindi na kailangan itingalang mating ang tinawa mating ang tinawa 2. Place 2 fingers in the mating ang tinawa chest just below the nipple line. Do not press tulong. mabuti ang mga kapapangatulong. centre of the infant's tulong. on the bottom of the breastbone (Figure 24). tulong. nak palang, hndi pa gaanong chest just below the 3. Push hard and fast. To give chest debelop ang kanilang leeg at nipple line. Dobreastbone not press compressions, press the infant’s daluyan ng hangin, at on the bottom of the down at least one third the depth of the masyado malaki at mabigat breastbone (Figure 24). chest (approximately 1 ft inches [4 cm]). ang kanilang ulo kaya sa pag3. Pushinhard and fashion fast. Toat Deliver compressions a smooth tingala nito lalo lamang naisagive chest compressions, .’ sara ang daluyan ng hangin.a rate of at least 100-120/min. the infant's breast4. At the end of eachpress compression, make sure bone down at least you allow the chest to recoil (reexpand) one depth of to theflow chest ft inches [4 cm]). Deliver completely. Chest third recoilthe allows blood into(approximately the heart and is1necessary compressions in a smooth fashion at a rate of at leastwill 100/min. .' to create blood flow during chest compressions. Incomplete chest recoil 4. At the end of each compression, make sure you allow reduce the blood flow created by chest compressions. Chest compression andthe chest to recoil (reexpand) Chest equal. recoil allows blood to flow into the chest recoil/relaxation times shouldcompletely. be approximately heart and is necessary to create blood flow during chest compressions. 5. Minimize interruptions in chest compressions. Incomplete chest recoil will reduce the blood flow created by chest compressions. Chest compression and chest recoil/relaxation times should be approximately equal. LIFELINE PREHOSPITAL EMERGENCY CARE 5. Minimize interruptions in chest compressions.

One-Rescuer Infant CPR

Two-Finger Chest Compression Technique

UNIT UNIT 1 1 DAY DAY 1 1

ng kang ng kang kakasyente, syente, syente, syente, ng ng beng bebeng betalamtalamtalamtalamyyy ng ng y ng ng ag ng ag ag ng ag ng ng

a bana bana banasyente bansyente syente syente amdaamdaamdaamdan yyy a n g n n a n g nbahan ya an ng g bahan bahan bahan ito’y ito’y ito’y ito’y

pagobpagobpagobpagobg pulso g g pulso gg pulso pulso dalag dalag dalag dalana na ng na ng ng na ng g pagg pagg paggg pagdibg g dibg dibdibgpung gpung gpung gpung ndang ndang ndang ndang o ng 2 o o ng 2 o ng ng 2 2

nitong nitong nitong nitong ng ulit. ng ulit. ng ulit. ng ulit. obserobserobserobserkung kung kung kung ulso ulso at ulso at at ulso at on na, on na, on na, on na, isyong isyong isyong isyong hndi hndi hndi hndi at hinat hinat hinat hing ang g ang g ang g ang g dug g dugag duduna ag ag na ag na na

FOUNDATION FOUNDATION OF OF EMT EMT PRACTICE PRACTICE 1-rescuer infant 1-rescuer BLS BLS for for an One-rescuer BLSanforinfant an infant

PARAAN NG CPR: 1. Suriin ang estado ng kamalayan ng pasyente, tapikin ng dalawang beses and parehong talampakan o kamay ng pasyente. Tumawag ng tulong. 2. Kapain ang pulso sa bandang braso ng pasyente habang pinakikiramdaman ang kanyang paghinga, obserbahan ang dibdib kung ito’y umaangat o hindi. 3. Kung sa iyong pagobserba ay wala itong pulso at hiniga, ilagay ang dalawang daliri sa gitna ng dibdib, simulan ang pagbomba ng kanyang dibdib ng (30) tatlongpung ulit na may sinusundang ritmo at bigyan ito ng 2 beses na hangin. 4. Ulitin ang ganitong proseso ng (5) limang ulit. 5. Muli itong tsekin at obserbahan, tignan ulit kung mayroon na itong pulso at hininga, kung meron na, ilagay sya sa posisyong komportable, kung hndi bumalik ang pulso at hininga ulitin lamang ang proseso hanggang dumating ang tinawag na tulong.

LIFELINE

PREHOSPITAL EMERGENCY CARE

Day 1

CRITICAL CONCEPTS

UNIT 1 DAY 1 Keep Head in Neutral Position.

If you tilt (extend) an infant’s head beyond the neutral (sniffing) position, the infant’s airway CRITICAL CONCEPTS may become blocked. Maximize airway patency by positioning the infant the in neck in a neutral Keepwith Head Neutral Position position so that the external If you tilt (extend) an ear infant's canal is level with the top head beyond theof the neutral infant’s shoulder. (sniffing) position, the infant's airway may become blocked. Maximize airway patency by positioning the infant with the neck in a neutral position so that the external ear canal is level with the top of the infant's shoulder.

Panatilihing nasa neutral position ang ulo ng bata. Kung sobrang nakatingala ang ulo ng bata, may posibilidad na lalong hindi ito makahinga. Sa neutral position -- kung saan pantay ang tenga ng bata sa ibabaw ng kanyang balikat-- mas madali itong makakahinga.

BASIC LIFE SUPPORT

Helping Infants Breathe With Barrier Devices FOUNDATION OF EMT PRACTICE

Infant Ventilation With Barrier Devices

Use barrier devices in the same manner as for adults.

To provide bag-mask ventilation, select a bag and mask of appropriate size. The Tomust provide bag-mask ventilation, select a bag mask of appropriate size. mask be able to cover the infant's mouth andand nose completely without cov-The ering must the eyes or overlapping chin.mouth Once and you nose selectcompletely the bag and mask,covering permask be able to cover the the infant’s without form a head tilt-chin liftthe to open victim's airway. the mask the infant's the eyes or overlapping chin. the Once you select thePress bag and mask,toperform a head face as you liftopen the infant's jaw, making a sealthe between the face the tilt-chin lift to the victim’s airway. Press mask to theinfant's infant’s faceand as you mask. Connect supplementary oxygen to the mask when available. lift the infant’s jaw, making a seal between the infant’s face and the mask. Connect

supplementary oxygen to the mask when available.

Why Breaths for for Infants & Children in Cardiac Why BreathsAre AreImportant Important Arrest and Children in Cardiac Arrest Infants When sudden cardiac arrest occurs (ie,the typical cardiac arrest in an adult), the When sudden cardiac arrest occurs, oxygen content of the blood is typically oxygen so content of the blood is typically normal, so compressions alone normal, compressions alone may maintain adequate oxygen delivery to themay heart maintain delivery to the heart and brain for the first few minand brain adequate for the firstoxygen few minutes after arrest. utes after arrest.

In contrast, infants and children who develop cardiac arrest often have respiratory In contrast, infants children who develop arrest even oftenbefore have the respirafailure or shock thatand reduces the oxygen contentcardiac in the blood onset of tory failure or shock that reduces the oxygen content in the blood even before arrest. As a result, for most infants and children in cardiac arrest, chest compressions the onset of arrest. As a result, for most infants and children in cardiac arrest, alone are not as effective for delivering oxygen to the heart and brain as the chest compressions alone are not as effective for delivering oxygen to the heart combination compressions breaths. For this it For is very and brain asof the combinationplus of compressions plusreason, breaths. thisimportant reason, it to is give both and breaths for infants and CPR.and children very compressions important to give both compressions andchildren breathsduring for infants during CPR.

Two-Rescuer Infant CPR

2-Rescuer Infant CPR

Two-Thumb-Encircling Hands Chest Compression Technique

2 Thumb-Encircling Hands Chest Compression Technique

The two-thumb-encircling hands technique is the preferred two-rescuer chest

The 2 thumb-encircling technique is the preferred chest comprescompression technique hands for healthcare providers who can2-rescuer fit their hands around the sion technique for technique healthcareproduces providersblood who flow can by fit compressing their hands around the ininfant’s chest. This the chest with fant's chest. This technique produces blood flowtechnique by compressing thebetter chestblood with both the thumbs. The 2 thumb-encircling hands produces both the thumbs. The 2 thumb-encircling hands technique produces better blood flow, more consistently results in appropriate depth or force of compression, and flow, more consistently results in appropriate depth or force of compression, and may generate higher blood pressures than the 2-finger technique. may generate higher blood pressures than the 2-finger technique.

LIFELINE

PREHOSPITAL EMERGENCY CARE

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

Follow these steps to give chest compressions to an infant using the 2 thumbencircling hands technique:

Two-Rescuer Infant BLS Sequence

1. Place both thumbs side by side in the center of the infant’s chest on the lower half of the breastbone. The thumbs may overlap in very small infants. 2. Encircle the infant’s chest and support the infant’s back with the fingers of both hands. 3. With your hands encircling the chest, use both thumbs to depress the breastbone approximately one third the depth of the infant’s chest (approximately 1.5 inches [4 cm]). 4. Deliver compressions in a smooth fashion at a rate of at least 100/ min. 5. After each compression, completely release the pressure on the breastbone and allow the chest to recoil completely. 6. After every 15 compressions, pause briefly for the second rescuer to open the airway with a head tilt-chin lift and give 2 breaths. The chest should rise with each breath. 7. Continue compressions and breaths in a ratio of 15:2 (for 2 rescuers), switching roles every 2 minutes to avoid rescuer fatigue.

1. Check the victim for a response and for breathing 2. If there is no response and no breathing or only gasping, send the second rescuer lo activate the emergency response system and get the AED for defibrillator). 3. Check the infant’s brachial pulse (take at least 5 But no more than 10 seconds). 4. If there is no pulse or if. despite adequate oxygenation and ventilation, the heart rate [pulse) is less than 60/min with signs of poor perfusion, perform cycles of compressions and breaths (30:2 ratio), starting with compressions. When the second rescuer arrives and can perform CPR. use a compression- ventilation ratio of 15:2. 5. Use the AED for defibrillator as soon as it is available

BLS for Healthcare Providers Course 1- and 2-Rescuer Infant BLS Skills Testing Criteria and Descriptors 1. Assesses victim (Steps 1 and 2, assessment and activation, must be completed within 10 seconds of arrival at scene): • Checks for unresponsiveness (this MUST precede starting compressions) • Checks for no breathing or only gasping

• 1 rescuer: 30 compressions to 2 breaths • Minimizes interrupt ions • Less than 10 sec between last compression of 1 cycle and 1st compression of next cycle 5. Switches at appropriate intervals as prompted by the instructor (for evaluation)

2. Sends someone to activate emergency response system (Steps 1 and 2, assessment and activation, must be completed within 10 seconds of arrival at scene): • Shouts for help/directs someone to call for help AND get AED/ defibrillator • If alone, remain with infant to provide 2 min of CPR before activating EMS

6. Provides effective breaths with bag-mask device during 2-rescuer CPR: • Provides effective breaths: • Opens airway adequately • Delivers each breath over 1 second • Delivers breaths that produce visible chest rise • Avoids excessive ventilation

3. Checks for pulse: • Checks brachial pulse • This should take no more than 10 seconds

7. Provides high-quality chest compressions during 2-rescuer CPR: • Correct placement of hands/fingers in center of chest • 2 rescuers: 2 thumb-encircling hands just below the nipple line • Compression rate of at least 100/min • Delivers 15 compressions in 9 seconds or less • Adequate depth for age • Infant: at least on third the depth of the chest (approximately 1½inches) • Complete chest recoil after each compression • Appropriate ratio tor age and number ol rescuers • 2 rescuers: 15 compressions to 2 breaths • Minimizes interruptions in compressions: • Less than 10 seconds between last compression of one cycle and first compression of next cycle

4. Delivers high-quality 1-rescuer CPR (initiates compressions within 10 seconds of identifying cardiac arrest): • Correct placement of hands* fingers in center of chest • 1 rescuer 2 fingers just below the nipple line • Compression rate of at least 100-120/min • Delivers 30 compressions in 18 seconds or less • Adequate depth for age • Infant: at least 1/3 the depth of the chest (approximately 1½ inches) • Complete chest recoil after each compression • Appropriate ratio for age and number of rescuers

LIFELINE

PREHOSPITAL EMERGENCY CARE

Day 1

BASIC LIFE SUPPORT

CRITICAL CONCEPTS The important thing is to be familiar with the AED you will be using, if possible, before you need to use it. When you are using an AED, remember to turn it on first and follow the prompts as it leads you through the rest of the steps.

AUTOMATED EXTERNAL DEFIBRILLATOR FOR INFANTS AND FOR CHILDREN FROM 1 TO 8 YEARS OF AGE LEARNING OBJECTIVES At the end of this section you will be able to • Choose the correct size AED pads for an infant or child younger than 8 years old • Tell when to attach and use an AED on an infant/child younger than 8 years old

Lubhang mahalaga na makabisado mo ang AED na iyong gagamitin. Pag-aralan mo na ito bago mo pa gamitin. Tandaan palagi: Kapag oras na ng emergency, wala nang panahon para mag-aral. Lahat ng gagawin mo ay dapat napag-aralan at napraktis mo na.

OVERVIEW There are a few special considerations when using an AED on an infant or child from 1 to 8 years of age.

Choosing the AED Pads or AED Child System Some AEDs have been modified to deliver different shock doses: one shock dose for adults and one for children. If you use a pediatric-capable AED, there are features that allow it to deliver a childappropriate shock. The method used to choose the shock dose for a child differs based on the type of AED you are using. If your AED includes a smaller size pad designed for children, use it. If not, use the Standard pads, making sure they do not touch or overlap.

Use of an AED for Infants and Children As in adults, use the AED as soon as it is available. Use child pads and a child system, if available, for infants and for children less than 8 years of age.

Use of an AED for Infants

For infants, a manual defibrillator is preferred to an AED for defibrillation. If a manual defibrillator is not available, an AED equipped with a pediatric dose attenuator is preferred.

Victims 8 Years of Age and Older • Use the AED as soon as it is available. • Use only adult pads (Figure 26). (Do NOT use child pads or a child key or child switch for victims 8 years of age and older.)

Victims Younger Than 8 Years of Age • Use the AED as soon as it is available. • Use child pads if available. If you do not have child pads, you may use adult pads. Place the pads so that they do not touch each other. • If the AED has a key or switch that will deliver a child shock dose, turn the key or switch..

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Advanced Airway CPR An advanced airway is a tool to assist the patient in breathing. One example is the bag-mask device Such contraptions are very useful for patients with suspected head injuries. If you will giveCPR with a patient with an advanced airway, the compression rate for 2-rescuer CPR is at least 100/min. You don’t need to pause to give breaths. Your partner can give breaths while you are doing the compressions. Take turns as compression can be tiring.

MOUTH-TO-MOUTH BREATHS Adult Mouth-to-Mouth Breathing Mouth-to-mouth breathing is a quick, effective way to provide oxygen to the victim. The rescuer’s exhaled air contains approximately 17% oxygen and 4% carbon dioxide. This is enough oxygen to meet the victim’s needs.

Follow these steps to give mouth-to-mouth breaths to the victim: 1. Hold the victim’s airway open with a head tiltchin lift. 2. Pinch the nose closed with your thumb and index finger (using the hand on the forehead). 3. Take a regular (not deep) breath and seal your lips around the victim’s mouth, creating an airtight seal. 4. Give 1 breath (blow for about 1 second). Watch for the chest to rise as you give the breath. 5. If the chest does not rise, repeat the head tilt-chin lift. 6. Give a second breath (blow for about 1 second). Watch for the chest to rise. 7. If you are unable to ventilate the victim after 2 attempts, promptly return to chest compressions.

CRITICAL CONCEPTS The use of an adult dose is better than no attempt at defibrillation. If you are using an AED for an infant or for a child younger than 8 years of age and the AED does not have child pads or a child key or switch, you may use the adult pads and deliver the adult dose. Place the pads so that they do not touch each other.

LEARNING OBJECTIVES At the end of this section you will be able to show how to give mouth-tomouth breaths.

OVERVIEW Because many cardiac arrests happen at home, you may need to give breaths to a family member or close friend when you are not working. This section shows how to give mouth-tomouth breaths when you do not have a pocket mask or bagmask.

Ang pagbibigay ng Adult Dose ay higit na mabisa kesa wala. Kung AED ang gamit sa bata na edad 8 pababa, at wala itong pads o switch para sa pambatang dosagem, gamitin mo na ang adult pads at bigyan ito ng adult dose. Iwasan na magdikit ang mga pads.

CAUTION: RISK OF GASTRIC INFLATION If you give breaths too quickly or with too much force, air is likely to enter the stomach rather than the lungs. This can cause gastric inflation.

Gastric inflation frequently develops during mouth-to-mouth, mouth-to-mask, or bag-mask ventilation. Gastric inflation can result in serious complications, such as vomiting, aspiration, or pneumonia. Rescuers can reduce the risk of gastric inflation by avoiding giving breaths too rapidly, too forcefully, or with too much volume. During CPR, however, gastric inflation may develop even when rescuers give breaths correctly. LIFELINE

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your patient that is present.

UNIT 1 FOUNDATION SHIELD BREATHS DAY MOUTH-TO-FACE 1

OF EMT PRACTICE

shield breathing is a ventilation technique with the use of a clear UNIT UNIT1Mouth-to-face 1 plastic on it.FOUNDATION This face shield hasOF different styles, some of them have EMTEMT PRACTICE Day 1 with valve FOUNDATION FOUNDATION OF OF EMT PRACTICE PRACTICE on it and instructions for better and faster usage. DAY DAY1drawings 1 Additional Techniques for Giving Breaths

Follow these steps to give mouth-to-face shield breaths to the victim: Additional Techniques for Giving Breaths 1. Place the face will shield on top of thetechniques patient’s face, insert the... These techniques broaden your in giving ventilations to your

These techniques willwill broaden your techniques in giving to yourcondition of 2. Hold the victim's airway open with a on head tilt-chin lift.to a specific Additional Additional Techniques Techniques for Giving Giving Breaths patients. Also this givefor you an ideaBreaths what to ventilations use patients. Also this will give you an idea on what to use to a specific condition of the 3. Pinch the nose closed with your thumb and index finger (using your patient that is present. your patient that is present. hand on the forehead). These These techniques techniques will will broaden broaden your your techniques techniques in in giving giving ventilations ventilations toto your your 4. Take athis regular (not deep) breath and seal your around the valve patients. patients. Also Also this will will give give you you anan idea idea onon what what toto use use toto alips specific a specific condition condition ofof Sa paggamit ng “ face MOUTH-TO-FACE SHIELD 5. patient Give that 1 that breath (blow for about 1BREATHS second). Watch for the chest to rise as your your patient is present. is present. shield” ugaliin pa you give the breath. din na panatilihing 6. If the chestshield does not rise, repeat head tilt-chin lift. with the use of a clear Sa paggamit ng “face shield” Mouth-to-face breathing is a the ventilation technique MOUTH-TO-FACE MOUTH-TO-FACE SHIELD SHIELD nakabukas ang daluyan Mouth-to-face shield breath breathing isBREATHS aBREATHS ventilation thefor usethe of achest to 7. Give a second (blow for about 1technique second). with Watch ugaliin pa din na panatilihing with valveon onit.it.This Thisface face shield different styles, of have them have ng hangin, pigain ng clear plastic plastic with valve shield hashas different styles, somesome of them rise. nakabukas ang daluyan ng drawings on it and instructions for better and faster usage. mabuti ang Mouth-to-face Mouth-to-face shield shield breathing breathing is a is ventilation a ventilation technique technique with with the the use use of of a clear a clear drawings on it and instructions for better and faster usage. 8. If you are unable to ventilate the victim after 2 attempts, promptly rehangin, pigain ng mabuti ang ilong habang plastic plastic with with valve onon it.compressions. it. This This face face shield shield has has different different styles, styles, some some ofof them them have have turn tovalve chest ilong habang nagbibigay ng drawings drawings onon it and it and instructions instructions forfor better better and and faster faster usage. usage. nagbibigay ng hangin hangin upang itoy tlga puFollow these steps to give mouth-to-face shield breaths to the victim: upang itoy tlga Follow stepsthe to face give shield mouth-to-face shield the victim: masok ng epektibo sa 1.thesePlace on top of the breaths patient’stoface, insert the... pumasok ng epektibo sa Follow Follow these these steps steps to to give give mouth-to-face mouth-to-face shield shield breaths breaths to to the the victim: victim:lift. pasyente. 2. Hold the victim's airway open with a head tilt-chin pasyente. 1. 1. Place Place the the face face shield shield onon top ofpatient’s of the the patient’s patient’s face, face, insert insert the... the... 1. Place face shield on top oftop the face. thumb 3. the Pinch the nose closed with your and index finger (using the 2. 2. Hold Hold the the victim's victim's airway airway open with a head atilt-chin head tilt-chin tilt-chin 2. Hold the victim’s airway openopen with awith head lift.lift.lift. hand on theclosed forehead). 3. 3. Pinch Pinch the the nose nose closed with with your yourthumb thumb and and index index finger finger (using (using the 3. Pinch the nose closed with your thumb and index finger (using the handthe on 4. Take a regular (not deep) breath and seal your lips around the valve hand hand on on the the forehead). forehead). the forehead). Give 1(not breath (blow for 1seal second). Watch for the chest to rise as 4. 4.5.Take a regular a regular (not (not deep) deep) breath breath and and seal your your lips lips around around the the valve valve 4. Take a Take regular deep) breath andabout seal your lips around the valve 5. 5. Give Give 1 breath 1give breath (blow (blow forfor about 1 second). 1 second). Watch for the the chest chest to rise rise as as you the breath. 5. Give 1 breath (blow for about 1about second). WatchWatch for thefor chest to rise asto you give you you give give the the breath. breath. 6. If the chest does not rise, repeat the head tilt-chin lift. Sa paggamit ng “face shield” the breath. 6. 6.7.If the If Give the chest chest does does not not rise, rise, repeat repeat the the head head tilt-chin tilt-chin lift.lift. SaSapaggamit paggamit ng“face “faceshield” shield” a second breath (blow for about 1 second). Watch for the chest to ugaliin pa din ng na panatilihing 6. If7.the chest notbreath rise, repeat the head tilt-chin lift. 7. Give Give a does second a second breath (blow (blow forfor about about 1 second). 1 second). Watch Watch forfor the the chest chest toto ugaliin ugaliinpapadin dinnanapanatilihing panatilihing rise. breath (blow for about 1 second). Watch for nakabukas ang daluyan ng 7. Give a second the chest to rise. rise. rise. nakabukas nakabukasang angdaluyan daluyanngng Ifyou you are unable to ventilate the2after victim after 2 promptly attempts, re8. If8.you unable to ventilate the victim after attempts, promptly returnretopromptly hangin, pigain ng mabuti ang 8.8.If are If you are are unable unable toto ventilate ventilate the thevictim victim after 22 attempts, attempts, promptly rehangin, hangin, pigain pigain ngng mabuti mabuti ang ang turn to chest compressions. chest compressions. ilong habang nagbibigay ng turn turn toto chest chest compressions. compressions. ilong ilonghabang habangnagbibigay nagbibigayngng hangin upang tlga puhangin hangin upang upangitoy itoy itoytlga tlgapupumasok masokng ngng epektibo epektibo epektibo sasa sa masok pasyente. pasyente. pasyente.

MOUTH-TO-FACE SHIELD BREATHS

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

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¹ American ¹ American Heart Heart Association. Association. “BLS “BLS for for Healthcare Healthcare Providers”, Providers”, Student Student Manual Manual (2010): (2010): 6-17. 6-17.

RESCUE BREATHING

ADULT, CHILD, AND INFANT RESCUE BREATHING OVERVIEW

This section tells how to do rescue breathing for adult, child, and infant victims.

Rescue Breathing

When an adult, child, or infant has a pulse but is not breathing effectively, rescuers should give breaths without chest compressions. This is rescue breathing.

Rescue Breathing for Adults Give one breath every 5 to 6 seconds (about 10 to 12 breaths per minute)

Rescue Breathing for Infants and Children Give one breath every 3 to 5 seconds (about 12 to 20 breaths per minute)

Give each breath every 1 second. Each breath should results in visible chest rise. Check the pulse about every 2 minutes.

NOTE:

In infants and children, if. despite adequate oxygenation and ventilation, the pulse is <60/min, perform cycles of compression and breaths (300:2).

RELIEF OF CHOKING

Foundational Facts Respiratory arrest is the absence of respirations (ie. apnea). During both respiratory arrest and inadequate ventilation, the victim has cardiac output (blood flow to the body) detectable as a palpable central pulse. The heart rate may be slow, and cardiac arrest may develop if rescue breathing is not provided. Healthcare providers should be able to identify respiratory arrest. When respirations are absent or inadequate, the healthcare provider must immediately open the airway and give breaths to prevent cardiac arrest and hypoxic injury to the brain and other organs.

Relief of Choking in Victims One Year Old and Older

LEARNING OBJECTIVES At the end of this section you will be able to show how to relieve choking in responsive and unresponsive victims.

OVERVIEW This section covers common causes of choking and actions to relieve choking in adults and children one year of age and older.

Respiratory arrest ang tawag kung ang pasyente ay may pulso pero hindi ito humihinga. Kailangan itong mabigyan ng rescue breaths upang maiwasan ang pagtigil ng tibok ng puso at pagkakaroon ng damage sa utak.

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Day 1

CRITICAL CONCEPTS Sometimes the choking victim may be unresponsive when you first encounter him or her. In this circumstance you probably will not know that an airway obstruction exists. Activate the emergency response system and start CPR (C-A -B sequence).

Choking FOUNDATION OFRecognizing EMT PRACTICE CRITICAL CONCEPTS

Early recognition of airway obstruction is the k

Sometimes the choking victim may portantAdult to distinguish Recognizing Choking a first Responsive or Childthis emergency from fain be unresponsive when in you

encounter him or her. In this cir- drug overdose, or other conditions that may require different treatment The trained o cumstance you probably will not is but Early recognition of airway obstruction the key to successful outcome. It is important to distinguish thisobstruction emergency from choking. fainting, stroke, heart attack, seizure, know that an airway drug overdose, or other conditions that may cause sudden respiratory distress but exists. Activate the emergency require different treatment. The trained observer can often detect may signs cause of choking. Foreign bodies a range of symptom response system and start CPR (C-A struction. -B sequence). Foreign bodies may cause a range of symptoms from mild to severe airway

ARE YOU CHOKING? UNIVERS

obstruction.

UNIVERSAL SIGN OF DISTRESS This sign of distress is seen commonly in patient suffering from foreign body airway obstruction. One or both hands are grasping the neck.

Mild Airway Obstruction Minsan ang isang biktima ng choking ay walang malay. Kaya hindi mo malalaman na may nakabara pala sa paghinga nito. Magsagawa agad ng CPR na ayon sa C-A-B sequence.

• Good air excahnge • can cough forcefully • may wheeze between coughs

• As long as good air continues, encourage the victim to continue spontaneous coughing and breathing effort • Do not interfere with the victim’s own attempt to expel the foreign body, but stay with the victim and monitor his or her condition. • If mild air obstruction persist, activate the emergency response system.

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• • • • • • •

Rescuer Actions

in a Responsi

Sa pagtyetyek ng taong This sign o nabubulunan, tanungin sya ng monly in pa isang bagay halimbawa” nabubulunan ka ba?” o di body kaya a eign ay “okay ka lang ba?”, ito or bothay h isang paraan upang malaman neck. mo kung anong antas na ng pagkakabara ng daluyan ng kanyang hangin. Kapag ito’y nakapag salita kahit hirap ito ay makokonsiderang “mild” o Severe Airway hndiObstruction kumpletong pagkakabara ng daluyan ng hangin., Poor or nosamantalang air excahnge kapag ito ay hndi Weak, ineffective cough or no cough at allnakaimik, salita o walang lumabas na inhaling hangin sa kanya, High-pitched noise while ay “severe” o kumpletong or no noiseito at all Increase respiratory difficulty pagkakabara ng daluyan ng Possible cyanoss (turning blue) hangin. Mahalagang alamin unable to speak ito bago ka pa makalapit sa Clutching the neck with the tumb kanya mabigyan ka na and fingers, makingupang the universal ng idea kung anong techchoking sign (figure 30) nique at lunas ang iyong gagawin.

Rescuer Actions

• Ask the victim if he or she is choking. If the victims nods yes and cannot talk, severe airway obstruction and you must try to relieve the obstruction.

Use abdominal thrusts (the Heimlich maneuver) to relieve choking in a responsive victim 1 year of age or older. Do not use abdominal thrusts to relieve choking in infants.

UNIT 1 DAY 1

iveGive Adult or Child each individual thrust with the intent of relieving the obstruction. It may be

necessary to repeat the thrust several times to clear the airway. key to successful outcome. It is imnting, stroke, heart attack, seizure, cause sudden respiratory distress AND OBESE VICTIMS CAUTION: PREGNANT observer can often detect signs of

Reliev Older

Relieving Choking in a Responsive Victim 1 Year of Age or Older

Use ab sive vic ing in in

If Pregnant Obese Victims perform chest to thrusts instead abdomiUseand abdominal thrusts (the Heimlich maneuver) relieve choking in of a responsive victim 1 year of age or older. Do not use abdominal thrusts to relieve choking in infants.

Give ea necessa

ms from mild to severe airway ob-

Give each individual thrust with the intent of relieving the obstruction. It may be Relieving Choking in an Unresponsive Victim 1 Year of Age necessary to repeat the thrust several times to clear the airway. Older SALorSIGN OF DISTRESS

CAUT

CAUTION: PREGNANT AND OBESE VICTIMS

Choking victims initially may be responsive and then may become unresponsive. of In distress is seen you comthis circumstance know that choking caused the victim's symptoms, and Pregnant Obese Victims chest thrusts instead of abdomiatient suffering from foryou know toIf look for and a foreign objectperform in the throat.

airway obstruction. One If a choking victim becomes unresponsive, activate the emergency response syshands are grasping the tem. Lower the victim to the ground and begin CPR, starting with compressions

Relieving Choking in an Unresponsive Victim (do not check for a pulse). 1 Year of Age or Older

Choking victims initially may be responsive and then becometo unresponsive. For an adult or child victim, every time you open themay airway give breaths, In this circumstance you know that choking caused the victim’s symptoms, you that open the victim's mouth wide and look for the object. If you see anand object know to look for a foreign object in the throat. can easily be removed, remove it with your fingers. If you do not see an object, keep doingIfCPR. After about 5 cycles or 2 minutes ofemergency CPR, activate the emera choking victim becomes unresponsive, activate the response gency response system if someone has not already done so. system. Lower the victim to the ground and begin CPR, starting with compressions (do not check for a pulse).

FOREIGNForBODY MANAGEMENT: an adult orAIRWAY child victim, OBSTRUCTION every time you open the airway to give breaths, open MILD

the victim’s mouth wide and look for the object. If you see an object that can easily be removed, remove it with your fingers. If you do not see an object, keep doing CPR. After about 5 cycles or 2 minutes of CPR, activate the emergency response system if OBSTRUCTION someone has not already done so.

FOREIGN BODY AIRWAY OBSTRUCTION 1. MANAGEMENT: Stand or kneel behind the victim and wrap your arms around the victim's

Follow these steps :

2. 3. 4.

chest supporting him/her from falling. Instruct the patient to cough forcefully. Help patient the foreign Followthethese steps expel : object by tapping his back (5) times while theor patient coughs 1. Stand kneel behind the forcefully. victim and wrap yourtime armsto around victim’s Check from timethe if the foreign chest supporting him/her from falling. object is expelled.

MILD OBSTRUCTION

If Preg Sa pagsusuri sa taong AREtanungin YOU nabulunan, mo siya ng isang bagay. CHOKING? Halimbawa: “Nabulunan ba?” O di kaya, Sa kapagtyetyek ng“Okay taong ka lang ba?”tanungin Ito ay isang nabubulunan, sya ng paraan upang malaman mo isang bagay halimbawa” kung gaanoka kagrabe nabubulunan ba?” oang di kaya sa daluyan ay pagkakabara “okay ka lang ba?”, ito ay isang paraan upang malaman ng kanyang paghinga. moKapag kung ito’y anong antas na ng nakapagsalita pagkakabara daluyan kahit medyong hirap, ito ay ng kanyang hangin. Kapag ito’y maikokonsiderang “mild.” nakapag salita kahit hirap Ang ibig sabihin ay hindi ito ay pa makokonsiderang “mild” o talaga kumpletong hndi kumpletongang pagkakabara nababarahan kanyang ng daluyan ng hangin., daluyan ng hangin. Kung samantalang kapag ito ay hndi hindi na ito nakapagsalita nakaimik, salita o walang o wala nang lumabas lumabas na hangin sa kanya, sa kanya, ito na ayhangin “severe” o kumpletong ito ay “severe” at pagkakabara ngnadaluyan ng nagpapahiwatig na talagang hangin. Mahalagang alamin ito barado bago na ka ang pa lagusan makalapit sa ng hangin. Mahalagang kanya upang mabigyan ka na mo kung gaano ng malaman idea kung anong techkagrabe ang bara nique at lunas ang para iyong gagawin. malaman mo kung anong lunas ang iyong gagawin.

Reliev or Old

Chokin In this c you kno

If a cho tem. Lo (do not

For an open th can eas keep d gency r

FORE MILD Follow 1. 2. 3. 4.

2. Instruct the patient to cough forcefully. 3. Help the patient expel the foreign object by tapping his back (5) times while the patient coughs forcefully. 4. Check from time to time if the foreign object is expelled

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

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¹ American

bigat nito. 3. Iatras ng likod dahan-dahan 2. Kapitan and braso 2.ng Kap paa sa habang ang ibinahang 4. Grasp your fist with your other hand and press your fist into the victim's pasyente o ilagay sa ilalim pas 3. these Iatras ng to dahan-dahan ang paa sathrusts likod habang ibina-ng Follow steps perform abdominal a responsive adult or child baba angon katawan kabu abdomen with a quick, forceful upward thrust. kili-kili ang iyongNG braso ng who is standing sitting: paa sa or likod habang ibinababa angna katawan ngnang PAGPAPAHIGA ISANG pasyente nakasandal liman 5. Repeat thrusts until the object is expelled from the airway or the victim upang masuportahan ang 1. baba Stand or kneel behind thepasyente victim andna wrap yourpaa. arms na around the vic- NG MALAY upa NWALAN NA katawan ngiyong nakasandal sa kabilang (pum becomesang unresponsive. bigat nito. big tim's waist PASYENTE: FOUNDATION EMT PRACTICE 1 na Day nakasandal na iyong kabilang paa. 4. saaGawin itodistinct nagOF paulit 6. pasyente Give each new thrust with separate, movement to relieve the 3. ulit Iatras ng dahan-dahan ang 3. CPR). Iatr 2. sa Make a fist with one hand. 1. pumosisyon ng patatsulo iyong kabilang paa. 4. Gawin ito nag paulit ulit obstruction. hanggang maibaba ng paa sa paa 3. Place the thumb side of your fist against the victim's abdomen, the habang oinlikod tripod, ito ay7.ibinaangUlitin pag 4. Gawin ito nag paulit hanggang ulit maibaba ngngbaba tayo ang katawan ng bab laayos ang katawan naka sa likod ng pasyent midline, slightly above the navel and well below the breastbone. Abdominal Thrusts With Victimlaayos Standing or Sitting ng hand ang katawan nginto pasyente na nakasandal pas pasyente. ang isang na paa a 4. hanggang Grasp your fistmaibaba with your other and press your fist thehabang victim's hang sa iyong kabilang paa. sa laayos ang katawan ng pasyente. sa likod na, at ang a quick, thrust. 5.forceful Suportahan angadultkanyang Followabdomen these steps with to perform abdominal thrustsupward on a responsive or child who is nakasuporta standing si 4. Gawin ito nag paulit 4. ulit Gaw 5. object Suportahan kanyang katawan a or sitting: 5. pasyente. Repeat thrusts until the from the airway or the victim ng pasyente ulois expelled habangang itong inilala-hanggang upan maibaba ng han nakasandal sa iyong kata 5. Suportahan ang kanyang ulo habang itong inilalabecomes unresponsive. sa sahig. 8. ngTseki 1. Stand or kneel behind the victim and wrap pag your arms around the victim’s waist laayoswan ang katawan laay na nakatagilid. 6. ulo each aTignan separate, distinct movement to relieve the habang itong with pag sa sahig. 2. Make aGive fist with one new hand. thrust 6.inilalaang daluyan ngpasyente. aypas 2.aboveKapitan and braso ng obstruction. 3. Place the thumb side of your fist against victim’s abdomen, in the midline, slightly the pag sa sahig. 6. the Tignan ang daluyan ng 5. Suportahan ang kanyang 5. Sup hangin at panatilihing napasyente o ilagay sapagh ilalim navel and well below the breastbone. daluyan ngyour fist atinto panatilihing uloa quick, habang inilalaulo 4. 6. GraspTignan your fist withang your other hand and hangin press thebigyan victim’s abdomen with kabukas ito, ngna-(5) ng kili-kiliitong ang iyong braso gawi forceful upward thrust. hangin at panatilihing kabukas naito, bigyan ng (5) pag sa sahig. pag upang masuportahan ang limang bomba sabecomes dibdib 9. Kung 5. Repeatkabukas thrusts untilito, the object is expelled from the airway or the victim unresponsive. 6. Tignan ang daluyan 6. ng Tign bigyan ng (5) limang bomba sa dibdib bigat nito. 6. Give each new thrust with a separate, distinct movement to relieve obstruction.sa (pumosisyon natheparang pulso at panatilihing nahan limang bomba sa dibdib (pumosisyon na parang sa hangin 3. Iatras ng dahan-dahan ang CPR). ang kabukas ito, bigyan ng (5) kab paa sa likod habang ibina (pumosisyon na parang sa 7. CPR). Ulitin hanggat Makita anglimang ablen bomba dibdib lima baba ang sakatawan ng CPR). 7. Ulitin hanggat Makita ang (pumosisyon na parang sa (pu nakabara sa daluyan ng maka pasyente na nakasandal n 7. Ulitin hanggat Makita nakabara ang sa daluyan ng hangin. Kapag ito’y nakikitaCPR). sa iyong kabilang paa. CPR nakabara sa daluyan hangin. ng Kapag ito’y nakikita 7. Ulitin hanggat ang 7. Ulit 4. Gawin itoMakita nag paulit ul na, sungkitin ito ng hinliliit hangin. Kapag ito’y nakikita na, sungkitin ito ng hinliliit nakabara sa daluyan ng nak hanggang maibaba ng upang tuluyang mailabas. Kapag ito’y nakikita han na, sungkitin ito ng hinliliit upang tuluyang mailabas. hangin. laayos ang katawan ng 8. Tsekin kung ang pasyente pasyente.ito ng hinliliit na, upang tuluyang mailabas. 8. Tsekin kung ang pasyente na, sungkitin ay may pulso pa atupang tuluyang mailabas. upa ang kanyang 8. Tsekin kung ang pasyente ay may pulso pa at 5. Suportahan 8. Tsekinulo kung ang pasyente 8. Tse paghinga, kung wala itong inilala ay may pulso pa paghinga, at kung wala ay may habang gawin ang CPR.; pag sapulso sahig. pa at ay paghinga, kung wala gawin ang CPR.; wala pag 6. Tignan kung ang daluyan ng 9. Kung positibo positibo naman namansasapaghinga, gawin ang CPR.; 9. Kung gawinhangin ang CPR.; gaw at panatilihing na pulso paghinga,ilagay ilagay 9. Kung positibo namanpulso sa atatpaghinga, 9. Kung kabukas positiboito,naman 9.sangKun bigyan (5 ang pasyente sa comportpulso at paghinga, ilagay pul pulso at paghinga, ilagay ang pasyente sa comportlimang bomba sa dibdib ablengposition positionpara parasya syaayayang pasyente sa comportang (pumosisyon na parang s ang pasyente sa comportableng ableng position para sya ay able makabawi ng lakas. CPR). ableng position para syamakabawi ay ng lakas. makabawi lakas. Makita mak 7. Ulitin ng hanggat ang makabawi ng lakas. nakabara sa daluyan ng hangin. Kapag ito’y nakikit na, sungkitin ito ng hinlili upang tuluyang mailabas. 8. Tsekin kung ang pasyent ay may pulso pa a paghinga, kung wal gawin ang CPR.; 9. Kung positibo naman s pulso at paghinga, ilaga ang pasyente sa compor ableng position para sya a makabawi ng lakas. NOTE: ForceApplied applied is is just just enough toto raise thethe patient feet off theoff ground. NOTE: Force enough raise patient feet the ground.

¹ American Heart Association. ¹ American Heart Association. “BLS“BL f

¹ American Heart Association. “BLS for Healthcare Providers”, Student M 52

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¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

pitanat and braso ng gin panatilihing na- BECOMES UNCONSCIOUS—DO CHEST NOTE: IFsaPATIENT syente o ilagay ilalim ukas ito, bigyan ng (5) kili-kili THRUST ang iyong braso G ng bomba sa dibdib ang masuportahan ang A mosisyon na parang sa gat nito. . ng dahan-dahan ang ras ok FROM TRIPOD TO SUPINE POSITION likod habang ibinanag- sa hanggat Makita ang ba angsa FROM katawan ngngTO SUPINE POSITION TRIPOD abara daluyan te syente na nakasandal na ay gin. Kapag ito’y nakikita iyong kabilang paa. g sungkitin ito ng hinliliit win ito nag paulit ulit ay ng tuluyang mailabas. nggang maibaba ng ain pasyente yoskung ang ang katawan ng syente. gmay pulso pa at portahan kanyang hinga, ang kung wala m oin itong inilalao habang ang CPR.; ggsa sahig. g positibo naman sa nan ang daluyan ng o at atpaghinga, ngin panatilihingilagay nag pasyente sa comportbukas ito, bigyan ng (5) ang position para sya ang bomba sa dibdibay g umosisyon parang sa abawi ng na lakas. na

R). tin lit hanggat Makita ang kabara sa daluyan ng g ngin. Kapag ito’y nakikita g sungkitin ito ng hinliliit ang g tuluyang mailabas. ekin a- kung ang pasyente may pulso pa at ghinga, kung wala g win ang CPR.; ang 5) positibo naman sa lso b at paghinga, ilagay g pasyente sa comportsa eng position para sya ay kabawi ng lakas. g g ta iit

te at a

sa ay rtay

PAGPAPAHIGA NG ISANG NAWALAN NG MALAY NA PASYENTE:

1. Pumosisyon nang patatsulok o tripod. Ito ay ang pagtayo sa likod ng pasyente habang ang isang paa ay nakasuporta sa likod at ang katawan ng pasyente ay nakasandal sa iyong katawan na nakatagilid. 2. Hawakan ang braso nito o ilagay sa ilalim ng kilikili ang iyong braso upang masuportahan ang bigat nito. 3. Iatras nang dahan-dahan ang paa sa likod habang ibinababa ang katawan ng pasyente na nakasandal na sa iyong kabilang paa. 4. Gawin ito nang paulit-ulit hanggang maibaba nang maayos ang katawan ng pasyente. 5. Suportahan ang kanyang ulo habang ito ay inilalapag sa sahig. 6. Tingnan ang daluyan ng hangin at panatilihing nakabukas ito. Bigyan ng 5 limang bomba sa dibdib (pumosisyon na parang sa CPR). 7. Ulitin hanggang makita ang nakabara sa daluyan ng hangin. Kapag ito’y nakikita na, sungkitin ito ng hinliliit upang tuluyang mailabas. 8. Suriin kung ang pasyente ay may pulso pa at paghinga. ¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17. Kung wala. gawin ang CPR. 9. Kung positibo naman sa pulso at paghinga, ilagay ang pasyente sa komportableng posisyon para siya ay makabawi ng lakas.

NOTE:

¹ American Heart Association. “BLSIffor Healthcare ¹ American Providers”, Heartunconscious, Association. Student Manual “BLS(2010): for Healthcare 6-17.thrust. Providers”, Student Manual (2010): 6-17. patient becomes do chest

LS Healthcare for Healthcare Providers”, Student Manual (2010): for Providers”, Student Manual (2010): 6-17.6-17.

Manual (2010): 6-17.

¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17.

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Day 1

LEARNING OBJECTIVES At the end of this section you will be able to show how to relieve choking in responsive and unresponsive infants.

OVERVIEW This section covers the steps to relieve choking (foreign-body airway obstruction) in an infant. For information on relieving choking in a child 1 year of age and older, see “Relief of Choking in Victims 1 Year of Age and Older.”

Tinatalakay dito ang mga hakbang na kailangan gawin para matulungan ang isang sanggol na biktima ng choking. Para lamang ito sa mga bata na wala pang isang taon ang edad.

FOUNDATION OF EMT PRACTICE

Sequence of Actions After Relief of Choking You can tell you have successfully removed an airway obstruction in an unresponsive victim if you • Feel air movement and see the chest rise when you give breaths • See and remove a foreign body from the victim’s mouth After you relieve choking in an unresponsive victim, treat him or her as you would any unresponsive victim (ie, check response, breathing, and pulse), and provide CPR or rescue breathing as needed. If the victim responds, encourage the victim to seek immediate medical attention to ensure that the victim does not have a complication from abdominal thrusts.

RELIEF OF CHOKING IN INFANTS Recognizing Choking in a Responsive Infant Early recognition of airway obstruction is the key to successful outcome. The trained observer can often detect signs of choking. Foreign bodies may cause a range of symptoms from mild to severe airway obstruction.

Mild Airway Obstruction • Good air excahnge • can cough forcefully • may wheeze between coughs

Rescuer Actions • Do not interfere with the infant’s own attempt to expel the foreign body, but stay with the victim and monitor his or her condition. • If mild air obstruction persist, activate the emergency response system.

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Severe Airway Obstruction • Poor or no air excahnge • Weak, ineffective cough or no cough at all • High-pitched noise while inhaling or no noise at all • Increase respiratory difficulty • Possible cyanoss (turning blue) • unable to cry

Rescuer Actions • If the infant cannot make any sounds or breathe, severe obstruction is present and you must try to relieve the obstruction.

force to using attempt dislodge the foreign body. each slap with sufficient blades, thetoheel of your hand. Deliver After delivering up to 5 back slaps, place your free hand on the infant's force to attempt to dislodge the foreign body. back, supporting the back of the infant's headfree with theon palm your After delivering up to 5 back slaps, place your hand theof infant's hand. The infant will be adequately cradled between your 2 forearms, back, supporting the back of the infant's head with the palm of your with palm of one supporting the face and jawyour while the palm hand.the The infant will hand be adequately cradled between 2 forearms, of the other hand supports the back of the infant's head. with the palm of one hand supporting the face and jaw while the palm 6. Turn infant as supports a unit while supporting the head and neck. of thethe other hand the carefully back of the infant's head. Hold the infant faceup, with your forearm resting on thigh. 6. Turn the infant as a unit while carefully supporting theyour head and Keep neck. the infant's head lower than the trunk. Hold the infant faceup, with your forearm resting on your thigh. Keep 7. Provide up head to 5 lower quick than downward chest thrusts in the middle of the the infant's the trunk. Clearing an object from an infant’s airway requires a combination of back slaps and chest thrusts. chest over the lower half of the breastbone (same in as for compres7. Provide up to 5 quick downward chest thrusts thechest middle of the Abdominal thrusts are not appropriate. sions during CPR). Deliver chest thrusts at a rate of about 1 per second, chest over the lower half of the breastbone (same as for chest compreseach with the intention creating enough force to dislodge forsions during CPR). Deliverofchest thrusts at a rate of about 1 per the second, eign body. each with the intention of creating enough force to dislodge the forFollow these steps to relieve choking in a responsive infant: 8. Repeat the sequence of up to 5 back slaps and up to 5 chest thrusts eign body. thethe object is removed the5 infant becomes 8. until Repeat sequence of uporto back slaps and unresponsive. up to 5 chest thrusts 1. Kneel or sit with the infant in your until the object is removed or the infant becomes unresponsive. lap. 5. 5.

Relieving Choking in a Responsive Infant

2. If it is easy to do, remove clothing from the infant’s chest. 3. Hold the infant facedown with the head slightly lower than the chest, resting on your forearm. Support the infant’s head and jaw with your hand. Take care to avoid compressing the soft tissues of the infant’s throat. Rest your forearm on your lap or thigh to support the infant. 4. Deliver up to 5 back slaps forcefully between the infant’s shoulder blades, using the heel of your hand. Deliver each slap with sufficient force to attempt to dislodge the foreign body. 5. After delivering up to 5 back slaps, place your free hand on the infant’s back, supporting the back of the infant’s head with the palm of your hand. The infant will be adequately cradled between your 2 forearms, with the palm of one hand supporting the face and jaw while the palm of the other hand supports the back of the infant’s head. 6. Turn the infant as a unit while carefully supporting the head and neck. Hold the infant faceup, with your forearm resting on your thigh. ¹ American Keep the infant’s head lower than the Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17. trunk. ¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010): 6-17. 7. Provide up to 5 quick downward chest thrusts in the middle of the chest over the lower half of the breastbone (same as for chest compressions during CPR). Deliver chest thrusts at a rate of about 1 per second, each with the intention of creating enough force to dislodge the foreignbody. 8. Repeat the sequence of up to 5 back slaps and up to 5 chest thrusts until the object is removed or the infant becomes unresponsive.

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1 Day 1

FOUNDATION OF EMT PRACTICE

RECOVERY POSITION FOR INFANT PATIENT

RECOVERY POSITION INFANT PATIENT Recovery position for infant FOR is theFOR burping position. RECOVERY POSITION INFANT PATIENT The infant must be put it this position after CPR to facilitate easy breathing and comfort while you are still assessing

him/her. Recovery position infant is the burping position. The infant must it thi Recovery position forfor infant is the burping position. The infant must bebe putput it this position after CPR facilitate easy breathing and comfort while you position after CPR to to facilitate easy breathing and comfort while you areare stillstill as-asFollow these steps: sessing him/her. sessing him/her. 1. Place your hands under the infant’s shoulder and one on his buttocks, support the infants body and weight while gently lifting him/her on to your chest facing your neck side. 2. Gently caress the infants back, let the infant stay with you for 5 minutes. . Do not give the infant back to his/her parent immediately to prevent unnecessary situation.

Follow these steps: Follow these steps: Place your hands under infant’s shoulder and one buttocks, sup1. 1. Place your hands under thethe infant’s shoulder and one onon hishis buttocks, support infants body and weight while gently lifting him/her your port thethe infants body and weight while gently lifting him/her onon to to your chest facing your neck side. chest facing your neck side. Gently caress infants back, infant stay with you 5 minutes. 2. 2. Gently caress thethe infants back, let let thethe infant stay with you forfor 5 minutes. . . Do give back his/her parent immediately prevent Do notnot give thethe back to to his/her parent immediately to to prevent un-unRelieving Choking ininfant aninfant Unresponsive Infant necessary situation. necessary situation. Do not perform blind finger sweeps in infants and children because sweeps may push the foreign body back into the airway, causing further obstruction or injury. If the infant victim becomes unresponsive, stop giving back slaps and begin CPR.

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To relieve choking in an unresponsive infant, perform the following steps:

1. Call for help. If someone responds, send that person to activate the emergency response system. Place the infant on a firm, flat surface. 2. Begin CPR (starting with compressions) with 1 extra step: each time you open the airway, look for the obstructing object in the back of the throat. If you see an object and can easily remove it, remove it. 3. After approximately 2 minutes of CPR (C-A-B sequence), activate the emergency response system (if no one has done so).

Lifeline in Action

CARDIAC ARREST

By Junep Ocampo

â&#x20AC;&#x201C; How we revived a patient on a moving ambulance WE REVIVED A PATIENT FOR THE FIRST TIME INSIDE A RUNNING AMBULANCE. IT WAS JUST THE BEST FEELING I HAD. INDEED, GOD USED US TO SAVE A LIFE.

There was this one run that I would never forget. We responded to a call for an unresponsive male adult. When we arrived, his caregiver was carrying him to the lobby bringing him towards us, I immediately did my BLS survey. The patient was in cardiac arrest, i immediately initiated CPR and advised to hook the patient to a monitor. The patient was asystole. My partner took over the CPR and I initiated an IV line. I was able to get a good line immediately so I prepared and gave an EPI dose. Two doses on scene and one upon loading on to the ambulance.

When we are en route to the hospital, I gave the fourth dose. While CPR was in progress, upon the next rhythm check, we detected a rhythm. I checked for the carotid pulse and it was strong. I couldnâ&#x20AC;&#x2122;t believe it at first that I tried checking it again to make sure it was real. And it was! We revived a patient for the first time inside a running ambulance. It was just the best feeling I had. Indeed, God used us to save a life.

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EMERGENCY Medical Service refers to a comprehensive system that provides personnel, equipment and facilities for the effective, coordinated and timely delivery of health services to victims of sudden illness or injury. Its goal is to save lives in times of medical emergencies. EMS as we practice and teach in Lifeline is an integral part of the Philippine health care system. Our Emergency Medical Technicians (EMTs) are the first point of contact for majority of people during emergencies and life-threatening injuries. They also act as gatekeepers for accessing hospital services after going through an emergency. The delivery of EMS in prehospital settings can be categorized broadly into two models, namely the FrancoGerman model and the Anglo-American model. These two

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models differ in their philosophy of delivery of care. The Franco-German model is based on the “stay and stabilize” philosophy. Its goal is to bring the hospital to the patients. Hence, their ambulances are virtual hospitals on wheels. What we use in Lifeline and what is used mostly in the Philippines is the Anglo-American model. It is based on the “scoop and run” philosophy and aims to rapidly bring patients to the hospital with less prehospital interventions. It is usually allied with public safety services such as the police or fire departments rather than public health services and hospitals. In this chapter you will learn how EMS fits into the Philippine healthcare system. By having a bird’s eye view of the role EMT’s play in providing healthcare services to sick and injured people, it is our hope that you, as a future EMT, would have a clearer understanding of your importance as a lifesaver.

DAY

Emergency Medical Service and The Healthcare System The Healthcare System The Well-being of an EMT Emotion and Stress Medical, Legal and Ethical Issues Crime Scene Preservation

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Day 2

CRITICAL CONCEPTS The modern Emergency Medical Services (EMS) system has been developed to provide what is known as prehospital or out-of hospital care. Its purpose is to get trained personnel to the patient as quickly as possible and to provide emergency care on the scene, en route to the hospital, and at the hospital until care is assumed by the hospital staff. The Emergency Medical Technician (EMT) is a key member of the EMS team.

to provide emergency care on the scene, en route to the hospital, and at the hospital until care is assumed by the hospital staff. The Emergency Medical Technician (EMT) is a key FOUNDATION OF EMT PRACTICE member of the EMS team.

The Emergency Medical Service and the Philippine Health Care System

INTRODUCTION Emergency Medical Service: Born on the battlefield

Binuo ang Emergency Medical Services o EMS upang makapagbigay ng mabilis na solusyon sa problemang pang kalusugan bago pa makarating ang pasyente sa ospital. Layunin nito na mapuntahan ng mga bihasang Emergency Medical Technicians ang pasyente at mabigyan ng agarang lunas habang papunta sa ospital o mismong sa ospital na.

The medical treatment of patient prior to and during transportation to the hospital traces its roots to the 18th century during Napoleon’s European campaigns. Napoleon’s physician, DominiqueJean Larrey, developed a system specifically for transportation of battle casualties (the “flying” ambulance), which was introduced into the United States Army during the Civil War. Later known as Emergency Medical Service, this kind of medical care figured prominently during the two World Wars, the Korean Conflict and the Vietnam War. In the Philippines, EMS began during the Philippine Revolution against Spain when volunteers like Melchora Aquino, known as Tandang Sora, helped members of the Katipunan who were wounded in battle. This kind of service was

eventually institutinalized with the birth of the local chapter of the International Red Cross during the Philippine-American war. It went on to become part of the local health care system through the years. The first official ambulance in the country was a horse-drawn carriage that dates back to the early 1920s. It was operated by the Philippine General Hospital which was established in 1911 by the Americans. Over the last 100 years, the EMS profession in the Philippines evolved with the times, influenced mostly by advancements in more advanced countries, particularly the United States. Today, EMS in the country is a thriving and well-established profession and many Filipino EMS practitioners have found opportunities for employment not only locally but abroad.

LEARNING OBJECTIVES • Identify the Health Care Services System in the Philippines. • Define Emergency Medical Services (EMS) systems. • Differentiate the roles and responsibilities of the EMT-Basic from other health care providers, prehospital care providers. Relate it to personal safety, safety of the crew, the patient and bystanders.

f n e l n M V b m 1 b

a T w t m i ( T t

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Note: Most of the information in this chapter, particularly the technical aspects of the well-being of Emergency Medical Technicians, were based on the book “Emergency Care” by Daniel Limmerand Michael O’Keefe. Used with permision from the book’s publisher, Pearsonn Education, Inc.

³ ⁴

health care providers, prehospital care providers. Relate it to personal safety, safety of the crew, the patient and bystanders.

INTRODUCTION

Levels of EMS training

The Emergency Medical Services System

There are four general levels of EMS training and certification. They vary from place to place. Emergency Medical Responder (EMR): This is designed for the person During Napoleonic injured soldiers werehealth transported who isthe often(1790) first at the scene, such asWars, police, firefighters, and industrial personnel. The emphasis is on activating the EMS system and providing immediate care from the battlefield to be cared for by physicians. The civil war saw the beginfor life-threatening injuries, controlling the scene, and preparing for the arrival of the ning of organized medical care with people like Clara Barton, who went on to ambulance. Emergency Medical Technician (EMT): In most areas, this is considered establish the Red Cross. Immediate care in fieldEMTs hospitals the the American minimum level of certification for ambulance personnel. providebehind basic-level lines by train wasand also pioneered. In World War volunteer personmedical trauma care and transportation to aI,medical facility.ambulance Advanced Emergency nel assistedMedical in theTechnician transport of the to hospitals. IN and thetransportation Korean War, (AEMT): Thewounded AEMT provides basic-level care as well as someHospital advanced-level care, including usingused, advanced airway devices, Mobile Army Surgical (MASH) units were and in both Korea and monitoring blood glucose levels, and Vietnam, helicopter transport was used for the wounded. These wars also administering some medications, brought about theinclude development which may intravenousof civilian hospitals specializing in the treatment of trauma. Non-military ambulance services began Operating in early and intraosseous administration. The paramedic 1900 in US;Paramedic: No requirements orperforms standards for equipment, crew training, or am1. Emergency Department/Hospital all of the skills of the EMT and that’s all!” bulance design – “You call, we haul, 2. Other specialized care facilities: AEMT plus advanced-level skills. The paramedic provides the most Laborstandards and a. Trauma In 1966,level theofNational Safety Act centers developede. EMS advanced prehospitalHighway care, delivery/ b. Burn centers and assisted states in upgrading the quality of emergency such as advanced assessment, drug pediatrics care. c. their Strokeprehospital centers therapy, EKG interpretation, and The establishment of EMS standards was d. spurred the 1966 government f. Poison control Cardiac by centers additional lifesaving white paper “Trauma: The skills.) Neglected Disease of Modern Society.” It dealt with

Components of the EMS System

Apat ang antas ng pagsasanay sa Emergency Medical Services. EMR o Emergency Medical Responder ang para sa mga taong unang dumarating sa eksena gaya ng pulis o bumbero. EMT o Emergency Medical Technicial naman ang pagsasanay para sa mga magtatrabaho sa ambulansya. AEMT ang susunod na antas dito. Ito ay ang Advanced EMT at para pa din sa mga nasa ambulansya. Ang pinakamataas na antas ay ang Paramedic. Ito ay nangangailangan ng ibayong pagsasanay. EMR at EMT lamang ang antas na maaaaring maabot sa mga pagsasanay sa Pilipinas.

the high number of deaths from traffic collisions due to inadequate emergency medical care. Since this was considered a highway safety issue at the time, EMS is regulated by the National Highway Traffic Safety Administration. The NREMT (1970) established national standards for testing and certifying EMS personnel. The NEMSSA (1973) made funds available to establish and upgrade EMS systems nationwide.

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Day 2

CRITICAL CONCEPTS Critical decision making is a very important concept. It essentially means that an EMT takes in information from the scene, the patient assessment, and other sources and makes appropriate decisions after synthesizing—or interpreting all of—the information. There are times when the information you obtain initially won’t be enough to be a basis for decision making, so you will need to ask more questions and perform additional examinations to gel everything you need to make a decision. It may be difficult to see how this all fits together now. Before long, however, you’ll be learning and practicing patient assessment and care. Some examples of critical decision making that will be a part of the assessment and care you will perform include: � Deciding which hospital to transport someone to. Should you take your patient to the closest hospital or to a more distant specialty hospital? � Deciding whether you should administer a medication to a patient. Will it help the patient’s current condition’? Could it make the condition worse? Iba’t iba ang ospital na puwedeng pagdalhan sa mga pasyente. Alamin kung ano ang mga katangian ng bawat ospital para mas mabilis na makapag-desisyon kung alin dito ang dapat puntahan.

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EMS AND THE HEALTHCARE SYSTEM

The Health Care System 1. Emergency departments 2. Specialty facilities

a. Trauma center for rapid surgical intervention and specialized treatment of trauma injuries that exceed the capability of standard Emergency Departments. b. Burn center for specialized treatment of serious burns and longterm care and rehabilitation. c. Obstetrical center for high-risk obstetric patients. d. Pediatric center for specialized treatment of infants and children. e. Poison center for specialized treatment of poisoning victims. f. Stroke center to provide specialized care for specific acute stroke patients. g. Cardiac center for the rapid and advanced management of patients suffering cardiac emergencies. h. Hyperbaric center for the treatment of certain toxic exposures, diving emergencies, and other conditions. i. Spine injury center for the management of severely spineinjured patients. j. Psychiatric center to care for patients with behavioral emergencies.

3. Hospital personnel

a. Physicians b. Nurses c. Other health professionals

4. Liaison with other public safety workers a. Local law enforcement b. Fire Departments

The ST. LUKE’S MEDICAL CENTER (SLMC) has provided high-quality healthcare for over a century. It was founded in 1903 with a mission to provide outstanding out-patient care. Today it is the foremost and most admired hospital in the Philippines and an acknowledged leader in Asia.

The PHILIPPINE HEART CENTER is the leader in upholding the highest standards of cardiovascular care, a selfreliant institution responsive to the health needs of the Filipino people. (VISION) http://www.phc.gov.ph http://www.phc.gov.ph/about-phc/index.php

The EAST AVENUE MEDICAL CENTER is a 600-bed, tertiary, general hospital under the Department of Health. It has the primary goal of providing quality medical care and treatment to patients irrespective of sex, socio-economic status and religious creed.

The PHILIPPINE GENERAL HOSPITAL, globally competitive and committed to the health of the Filipino people, through networking and teamwork of competent, compassionate and ethical health professionals, shall be the center of excellence and leadership in health care training and research that impacts on health policies. (VISSION)

Today, the JOSE R. REYES MEMORIAL MEDICAL CENTER is one of the outstanding hospitals in the country, known for its exceptional medical service, training and research. Yet it has also established itself as the prime facility for indigent patients, providing the same quality of service. Since its inception, the hospital has been providing quality healthcare to million.

The LUNG CENTER OF THE PHILIPPINES was established through Presidential Decree No. 1823 on January 16, 1981 to provide the Filipino people state-of-the-art specialized care for lung and other chest diseases. http://www.lcp.gov.ph/history.html

The DR. JOSE FABELLA MEMORIAL HOSPITAL shall be the national center for the attainment of optimum reproductive health for all. (VISION) http://fabella.doh.gov.ph/

The DEPARTMENT OF HEALTH (DOH) is the principal health agency in the Philippines. It is responsible for ensuring access to basic public health services to all Filipinos through the provision of quality health care and regulation of providers of health goods and services. http://www.doh.gov.ph/ http://www.doh.gov.ph/about.html

http://www.pgh.gov.ph/en/ http://www.pgh.gov.ph/en/about-us/

The goal of the NATIONAL KIDNEY AND TRANSPLANT INSTITUTE (NKTI) is toe provide world class health care to all patients and their families and to pursue excellence in developing and establishing the highest level of training and research for physicians and paramedical personnel. The Institute has a long and distinguished history of service and medical excellence. It operates the busiest transplantation program in the country including kidney, liver, pancreas, stem cell, & bone marrow. http://www.nkti.gov.ph/ http://www.nkti.gov.ph/about.do?id=6602

² Limmer (Brady) ³ Pollack, (AAOS) 4 NHTSA

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UNIT 1 DAY 2

Day 2

FOUNDATION OF EMT PRACTICE

CRITICAL CONCEPTS

The Emergency Medical Technician’s Well-Being 

Hindi lamang sa oras ng pangangailangan maaasahan ang mga EMTs. Nandyan din sila para magbigay kaalaman sa komunidad at turuan ang mga mamamayan kung papaano maiiwasan ang disgrasya o karamdaman. Ginagabayan din nila ang mga tao kung papaano makakapaghanda sa mga kalamidad at iba pang mga trahedya na hindi inaasahan.

• Indicate the potential emotional reactions that the EMT may experience when faced with trauma, illness, death and dying. • Tabulate the EMT’s way of approach to the family encountering death and dying. • Recognize the importance of body substance isolation (BSI).

Personal safety. It is not possible P to help a patient if you are int jured before you reach him or while you arc providing care, so i your first responsibility is to keep r yourself safe. m  Safety concerns include dangers m from other human being*, anid mals, unstable buildings, fires, o explosions, and more. Though emergency scenes are usually safe, they also can be unpredictt able. You must take care at all t times to stay safe. b  Safety of the crew, patient, and c Personal Protection bystanders. The same dangers t CRITICAL CONCEPTS you face will also be faced by a others at Equipment the scene. Asand a profesprocedures t w sional,ofyou be concerned fluids themust patient are referred to as e with their safety as well and as your  Personal safety. It is not possible Protective Equipment Hand Was own.to determine to help a patient if you are inYour job as an EMT is to help a sick or tion injured patient. the most appropriat a jured before you reach him or But it will not be while possible youcare, to so do your job ifPrecautions you are are needed agail you arc for providing infection: inhalation risks such as TB ( your first responsibility is to keep sick or injured yourself. Your first responsibility is to keep or drinking in an risks such as eating yourself safe. T mouth with contaminated fingers; ab yourself safe.  Safety concerns include dangers B membranes and eyes; and injection r from other human being*, ani-also be faced by others at The same dangers you face will dle. These four routes will also be im mals, unstable buildings, fires, r overdoses, materials, and b and more. Though the scene. Hence,explosions, you must be concerned with theirhazardous safety as emergency scenes are usually Local protocols will dictate wa well as your own.safe, they also can be unpredictt that putting gloves on prior to leavin Youimportant must take care atfunctions all tearing while carrying equipment. Gs One of your able. most is patient times to stay safe. blood or body fluids should be remov assessment, or finding outcrew, enough information about the Safety of the patient, and computers, and other equipment. Alw The sameemergency dangers patient to providebystanders. appropriate care. Based onthat is damaged or c to replace a pair you face will also be faced by a manner that does not allow the co your assessment,others you atwill be able to help the patient deal the scene. As a profesLimmer (Brady) “ with bare skin. Disposable³² arm Pollack, covers (AAOS) sional, you must be concerned ⁴ NHTSA with and survivewith an their illness injury. exposed skin when wearing short slee safety or as well as your Proper hand washing techni own. Since you will mostly be involved in transporting

UNIT 1 DAY 2

LEARNING OBJECTIVES

FOUNDATION

INTRODUCTION

an essential component of personal p

patients to the hospital, lifting and moving lar patients bearea between fin attentionwill to the nails. (Remember, it is the friction tha your usual tasks. The minimum time spent washing sh It is a serious responsibility to operate an ambulance at hands dry red Birthday” twice. Patting also consider cove any time, but even more so when there is a patientYou onmay board. reduce the spread of droplet-borne d Upon arrival at the hospital, you will transfer the ofand themonitor the airw ability to care observe thatabandon others are complying with stan patient to hospital personnel. You must never care safety of others as well as reducing the of the patient until transfer has been properly completed. \ As an EMT, you are an advocate -- the person who speaks up for your patient and pleads her cause. Your role wil enable hospital staff to save the patient’s life—or as “ simple as making sure a relative of the patient is notified.

Roles and Responsibilities of the EMT-Basic 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 64

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Personal safety Safety of crew, patient and bystanders Patient assessment Patient care based on assessment findings Lifting and moving patients safely Transport/transfer of care Record keeping/data collection Patient advocacy (patient rights) - patient as a whole Readiness Leadership Decision Making and Good Judgment Medical and Legal Standards Administrative Support Professional Development

² Lim ³ Po ⁴ N

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

FOUNDATION OF EMT PRACTICE

Personal Protection

Equipment and procedures that protect against the blood and body fluids of the patient are referred to as Standard Precautions such as Personal Protective Equipment and Hand Washing. The EMT must assess each situation to determine the most appropriate level of personal protection. Precautions are needed against the four types of risks, or routes of infection: inhalation risks such as TB (protection from HEPA mask); ingestion risks such as eating or drinking in a contaminated area, or touching your mouth with contaminated fingers; absorption risks such as through mucous membranes and eyes; and injection risks such as being stuck by a dirty needle. These four routes will also be important when discussing poisonings, overdoses, hazardous materials, and bioterrorism. Local protocols will dictate when you should wear gloves. Be aware that putting gloves on prior to leaving the unit may make them prone to tearing while carrying equipment. Gloves that may be contaminated with blood or body fluids should be removed or changed before handling radios, Responding to a difficult call? You ² Limmer (Brady) computers, and other equipment. Always carry extra gloves in case you need ³ Pollack, (AAOS) canis damaged better deal with it if you have a gloves in to replace a pair that or contaminated. Always remove ⁴ NHTSA a manner that does not allowsystem. the contaminated surface to come in contact that protect againstsupport the blood and body Family, EMS colleagues, with bare skin. Disposable arm covers can be used to reduce the amount of s Standard Precautions such as Personal and friends who shirts. are there for you every exposed skin when wearing short sleeve shing. The EMT must assess each situaProper hand washing technique prevents the spread of disease; it is day are vital for your well-being. An te level of personal protection. an essential component of personal protection. While washing, pay particuinst the four typesexercise of risks, or program routes of helps inand many lar attention to the area between fingers,also the nail beds, under finger(protection from HEPA mask); ingestion nails. (Remember, ways. it is the It friction that removes the material, not the soap.) builds contaminated area, or touching yourstrength, improves The minimum time spent washing should be long enough to sing “Happy bsorption risks suchflexibility, as through mucous promotes cardiovascular Birthday” twice. Patting hands dry reduces abrasion of the skin. risks such as being stuck by a dirty neeand helps you manage You may fitness, also consider covering the patient’s faceyour with a mask to mportant when discussing poisonings, reduce the spreadweight. of droplet-borne disease. However, this will restrict your bioterrorism. abilityyou to observe and monitor the airway. It is also a good idea to make sure when should wear gloves. Be Lack ofaware sleep isprecautions. a factor in that others with standard Thismedical is assuring the ng the unit are maycomplying make them prone to safety of others well as reducing the risk to you. and improper decision-making. Gloves that may as beerrors contaminated with

N OF EMTMaintaining PRACTICE

CRITICAL CONCEPTS

Well-Being

system function. Eating provides fuel for the body— important during long EMS shifts and with strenuous activities. Eating the right food is critical. Excess alcohol intake reduces performance and brings on personal, medical, and social issues. Caffeine may seem like a necessity at the moment, but your body will take only so much artificial stimulation before it crashes. Decision-making and reaction time can be impaired. See your physician regularly and keep up-to-date on vaccines. Regular check-ups ensure you are well.

ved or changed before handling radios, the potential for Fatigue increases ways carry extra gloves in case you need motor vehicle collisions, harms personal contaminated. Always remove gloves in ontaminated surfacerelationships, to come in contact and depresses immune s can be used to reduce the amount of eve shirts. ique prevents the spread of disease; it is protection. While washing, pay particungers, the nail beds, and under fingerat removes the material, not the soap.) hould be long enough to sing “Happy Safety is the first priority of an EMT. There are equipment and duces abrasion of the skin. procedures that ensure your safety and protection against the blood ering the patient’s face with a mask to disease. However, this will restrict your and body fluids of the patient. These are part of what we cal Standard way. It is also a good idea to make sure Precautions and include personal protective equipment and hand ndard precautions. This is assuring the e risk to you. washing.

mmer (Brady) ollack, (AAOS) NHTSA

Personal Protection

As an EMT, you must assess each situation to determine the most appropriate level of personal protection. Observe precautions against the four types of risks, or routes of infection: 1. Inhalation risks such as getting infected with tuberculosis; 2. Ingestion risks such as eating or drinking in a contaminated area, or touching your mouth with contaminated fingers; 3. Absorption risks such as through mucous membranes and eyes; And 4. Injection risks such as being stuck by a dirty needle. These four routes will also be important when discussing poisonings, overdoses, hazardous materials, and bioterrorism. Local protocols will dictate when you should wear gloves. Be aware that putting gloves on prior to leaving the unit may make the gloves prone to tearing while carrying equipment. Gloves that may be contaminated with blood or body fluids should be removed or changed before handling radios, computers, and other equipment. Always carry extra gloves in case you need to replace a pair that is damaged or contaminated. Always remove gloves in a manner that does not allow the contaminated surface to come in contact with bare skin. Disposable arm covers can be used to reduce the amount of exposed skin when wearing short sleeve shirts. Proper hand washing technique prevents the spread of disease; it is an essential component of personal protection. While washing, pay particular attention to the area between fingers, the nail beds, and under fingernails. The minimum time spent washing should be long enough to sing “Happy Birthday” twice.

� PERSONAL SAFETY -- It is not possible to help a patient if you get injured before you reach him or while you are providing care. So your first responsibility is to keep yourself safe. � BE PREPARED FOR ANYTHING -- Though emergency scenes are usually safe, they can be unpredictable. You must take care at all times to stay safe. Safety concerns include dangers from other people, animals, unstable buildings, fires, explosions, etc. � SAFETY OF OTHERS -- The same dangers you face will also be faced by others at the scene. As a professional, be concerned about the safety of your team, the patient, and bystanders, as well as your own.

Hindi makatutulong ang isang EMT sa ibang tao kung siya mismo ay malalagay sa peligro. Kaya naman napakaimportante na maging ligtas sa lahat ng oras ang isang EMT. Maging maingat sa paghawak sa mga kemikal, pagpasok sa lugar na nasusunog, at seguruhin na protektado ang sarili bago subuking tumulong sa iba.

LIFELINE

PREHOSPITAL EMERGENCY CARE

Day 2

THE WELL-BEING OF THE EMT

CRITICAL CONCEPTS DISEASE SURVEILLANCE -At the frontlines, the reports of the EMS may serve as an indication that a trend in injury or disease is beginning. This may range from flu to violence to terrorist attacks. ROUTES OF TRANSMISSION � Droplet contact – coughing or sneezing on another person � Direct physical contact – touching an infected person, including sexual contact � Indirect physical contact – usually by touching soil contamination or a contaminated surface � Airborne transmission – if the microorganism can remain in the air for long periods � Fecal-oral transmission – usually rom contaminated food or water sources � Vector borne Transmission by insect or animal (Mosquitoes and malaria.) Ang EMS ang unang nakakaalam kung may namumuong problema sa isang lugar. Puwede nitong alamin kung ang problema ay umpisa lamang ng isang mas mabigat na kondisyon gaya ng pagkalat ng epidemya tulad ng dengue, o pag-atake ng mga terorista na gumagamit ng biological weapon.

DISEASES OF CONCERNS Hepatitis B and C There are several forms of hepatitis, including A, B, and C. Hepatitis A is acquired primarily through contact with food or water contaminated by stool (feces). The other forms are acquired through contact with blood and other body fluids. Hepatitis B has been shown to live for many days in dried blood spills, posing a risk of transmission long after other viruses have died. Assume that any body fluid in any form is infectious until proven otherwise. Hepatitis B can be deadly. Today, hepatitis C infects many EMS providers, as hepatitis B did. There is still no vaccine against hepatitis C. It may stay dormant in the body for many years before symptoms develop. Many EMS personnel who worked in the field prior to the adoption of standard precautions were infected and are just now showing signs of infection

Tuberculosis (TB) Tuberculosis (TB) is an infection that sometimes settles in the lungs and can be fatal. It was once thought to be eradicated, but it made a comeback in the late 1980s. Health care workers and others can become infected even without direct contact with a carrier. Because it is impossible for the EMT to determine why a patient has a productive cough, it is safest to assume that it could be the result of TB and that necessary respiratory precautions should be taken. This is especially true in institutions such as nursing homes, correctional facilities, or homeless shelters where there is an increased risk of TB.

HIV/AIDS Although HIV/AIDS is at present incurable, it presents far less risk to health care workers than hepatitis and TB because the virus does not survive well outside the human body. This limits the routes of exposure to direct contact with blood by way of open wounds, intravenous drug use, unprotected sexual contact, or blood transfusions. Puncture wounds into which HIV is introduced, such as with an accidental needlestick, are also potential routes of infection. However, less than a half of 1 percent of such incidents result in HIV infection, according to OSHA, compared to 30 percent for the hepatitis B virus (HBV). The difference is due to the quantity and strength of HBV compared to HIV.

Sever Acute Respiratory Syndrome (SARS) SARS has caused worldwide concern. It appears to be spread through respiratory droplets, by coughing, sneezing, or touching something contaminated and then touching nose or eyes. Protection against SARS in a patient-care setting includes frequent hand washing and use of gloves, gowns, eye protection, and an N-95 respirator.

LIFELINE

PREHOSPITAL EMERGENCY CARE

Flu (e.g. Influenza, Avian Flu, Swine (H1N1) flu) There are many strains of flu including each year’s seasonal flu. You will likely be called to treat and transport patients who have the flu or flu-like symptoms. Take Standard Precautions for respiratory diseases and treat these patients as you will be trained to do during your course. Outbreaks of avian flu have been seen in Asia, the Near East, and Africa and have been fatal in about half of reported cases. It is not at this point easily transmissible from human to human. Symptoms include traditional flu-like symptoms

that progress to more severe conditions such as pneumonia and acute respiratory distress syndrome. Precautions are the same as for SARS. EMS is on the front lines of flu care. EMTs can help prevent its spread by recognizing symptoms and placing a mask on any potential flu patient before entering a hospital. The Department of Health routinely communicates with EMS agencies to provide updates and advice on preventing the spread of flu.

INFECTION CONTROL AND THE LAW Authorities have taken several steps to ensure the safety of people who are in high-risk positions. The Philippine government, particularly the Occupationl Safety and Health Center under the Department of Labor and Employment, has developed standards and guidelines for protection of workers whose jobs may expose them to infectious diseases. In fact, there is an Occupational Safety and Health Code passed in 2004 for this purpose.

Occupational Exposure Control Plan Infection exposure control plan identifies and documents, job classifications, and tasks with a possibility of exposure to infectious body fluids; identifies methods used for communicating hazards to employees, postexposure evaluation, and follow-up. Without active participation of employer and employees, any workplace infection control program is destined to fail. Be sure your system has an active and up-to-date infection exposure control plan and that you and fellow EMTs follow it at all times.

Occupational exposure Control Plan Content Training is required as to general explanations of how diseases are transmitted, uses and limitations of practices that reduce or prevent exposure, and procedures to follow if exposure occurs. Hepatitis B vaccination is provided free of charge to employees and at a reasonable time and place. Personal protective equipment is provided to employees at no cost. Must not permit blood or infectious materials to reach an EMT’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes. Engineering controls remove potential infectious disease hazards or

separate the EMT from exposure. Work practice controls improve the manner in which a task is performed to reduce risk of exposure. EMT and employer are both responsible for maintaining clean and sanitary conditions of the emergency response vehicles and work sites. Standard requires labeling containers used to store, transport, or ship blood and other potentially infectious materials, including use of the biohazard symbol. EMTs must immediately report suspected exposure incidents— including mucous membrane or broken-skin contact with blood or other potentially infectious materials.

Ambulance Crew Risk and Immunizations EMS personnel are strongly encouraged to take advantage of the immunizations available to them. Your training program may also require you to have a physical exam and/or obtain immunizations before participating in patient care.

LIFELINE

PREHOSPITAL EMERGENCY CARE

Day 2

THE WELL-BEING OF THE EMT

EMOTION AND STRESS Ang stress ay isang karaniwang reaksyon ng katawan ng tao sa isang hindi pangkaraniwang pangyayari. Kadalasan, ito ang nagiging reaksyon sa mga kalamidad o trahedya tulad ng pagbagsak ng eroplano o pagkamatay ng isang tao. Normal lamang sa isang EMT ang makaranas ng stress. Sa mas maraming sitwasyon, hindi ito kailangang gamutin. Kailangan lang palipasin. Ibang kaso kapag ang isang EMT ay walang tigil sa pag-iyak o hindi na makapagisip nang normal dahil sa stress. Bihira naman ang ganitong kaso. Sa karamihan ng EMT, ang stress ay lumilipas nang hindi nangangailangan ng tulong propesyunal.

LEARNING OBJECTIVES • Recognize the manifestations of critical incident stress. • State possible steps that the EMTBasic may take to alleviate stress.

INTRODUCTION Stages of Stress 1. First stage: Alarm Reaction (Fight or Flight) 2. Second stage: Resistance (coping) 3. Third stage: Exhaustion

In an emergency situation, our body’s nervous system increases its activity (or the fight-or-flight syndrome). The pupils of our eyes dilate, our heart rate increases, and our blood sugar level increases, our digestive system slows down, our blood pressure rises, and blood flow to skeletal muscles increases. Endocrine system produces more cortisol, which influences metabolism and immune response and is critical to the body’s ability to adapt to and cope with stress. When we finaly get to cope with the situation, body systems return to normal functioning. The physiologic effects of sympathetic nervous system stimulation and excess cortisol are gone. Many factors contribute to ability to cope: physical and mental health, education, experiences, and support systems, such as family, friends, and coworkers. During exhaustion, physiologic effects described by Selye include what he called the stress triad: enlargement (hypertrophy) of adrenal glands, which produce adrenaline; wasting (atrophy) of lymph nodes; and bleeding gastric ulcers. The individual loses the ability to resist or adapt to the stressor and may become seriously ill as a consequence. Most individuals do not reach this stage.

Acute Stress Reaction Acute stress reactions are often linked to catastrophes, such as a large-scale natural disaster, a plane crash, or witnessing the death of a family member or a close friend. They are ordinary reactions to extraordinary situations. They reflect the process of adapting to challenges. They are normal and are not a sign of weakness or mental illness. Any sign or symptom in a patient or an EMT that indicates an acute medical problem (such as chest pain, difficulty breathing, or abnormal heart rhythms) or an acute psychological problem (such as uncontrollable crying, inappropriate behavior, or a disruption in normal, rational thinking) are the kinds of problems that demand immediate corrective action. Some signs and symptoms may not require intervention. You may feel confused or have trouble concentrating or difficulty sleeping after working at a bloody crash scene or a prolonged extrication. You may find that you have no appetite for food or cannot get enough to eat. If not too severe or longlasting, these responses are uncomfortable but probably not dangerous, since they pose no immediate threat to your health, safety, or well-being.

LIFELINE

PREHOSPITAL EMERGENCY CARE

Delayed Stress Reaction

Cumulative Stress Reaction

Delayes stress reactions are what experts call as Post-Traumatic Stress Disorder. These can be triggered by a specific incident. Their signs and symptoms may not become evident until days, months, or even years later. Signs and symptoms may include flashbacks, nightmares, feelings of detachment, irritability, sleep difficulties, or problems with concentration or interpersonal relationships. It is not uncommon for persons suffering from such disorder to seek solace through drug and alcohol abuse. Because of the delay and the apparent disconnect between the triggering event and the response, the post-traumatic stress disorder patient may not understand what is causing the problems.

Cumulative stress reaction, or burnout, results from sustained, recurring low-level stressors—possibly in more than one aspect of one’s life—and develops over a period of years. The earliest signs are subtle. If problems are not identified and managed at this point, the progression will continue. If you are suffering from burnout, you may develop physical complaints such as headaches or stomach ailments, significant sleep disturbances, loss of emotional control, irritability, withdrawal from others, and increasing depression. Without appropriate intervention, your physical, emotional, and behavioral condition will continue to deteriorate, with manifestations such as migraines, increased smoking or alcohol intake, loss of sexual drive, poor interpersonal relationships, deterioration in work performance, limited self-control, and significant depression. To manage burnout, you, as an EMT, must seek balance in your life.

Causes of Stress There are many causes of stress, and these causes may vary from individual to individual. As an EMT, you must learn to recognize your own stressors and to detect the signs of stress in your life. A multiple casualty incident is a single incident with multiple patients, ranging from a motor-vehicle crash in which two drivers and a passenger are injured to a hurricane causing injury to hundreds of people. Calls involving infants and children, involving anything from a serious injury to sudden infant death syndrome (SIDS), are particularly stressful to health care providers. Expect a stress reaction when your call involves injuries that cause major trauma or distortion to the human body. Examples include amputations, deformed bones, deep wounds, and violent death.

Maraming puwedeng maging dahilan ng stress. Importante na malaman ng isang EMT kung ano ang bagay na nakakastress sa kanya at alamin kung papaano niya ito maiiwasan o makokontrol.

Cases of abuse and neglect occur in all social and economic levels of society. You may be called to treat an infant, child, and adult or elderly abuse victim. A bond is formed among members of the public services. The death of another public-safety worker—even a stranger—can cause a stress response. Stress may also stem from a combination of factors, including problems in your personal life. For example, your EMS organization may require you to work weekends and holidays. Friends and family members may not understand why you cannot participate in certain social activities or why you cannot leave a certain area. You may wish to share your feelings after a difficult call with a friend or someone you love, but the person does not understand your emotions. This can lead to feelings of separation and rejection. Any incident may affect you and your co-workers differently. Try never to make negative judgments about another person’s reaction. LIFELINE

PREHOSPITAL EMERGENCY CARE

hese concerns with them. Have them talk to Critical incident stress debriefing specially those who have been working for ping strategies they have developed.

(CISD)

EMS organizations have different systems for preventing stress and for dealing with critical incident and WELL-BEING chronic stress,OF including wellness THE THE EMT Daystress 2 nges - Request work shifts allowing for more incentives, professional counseling, and peer support. Medical professionals ds; Request rotation dutythat assignment to and aEMS leadersofagree the best course of action for an EMT who is having sional help. significant stress from a serious call or experience is to seek help from a mental Signs and symptomswho of stress are these issues. It is quite likely that family and co-workers recognize these signs health professional treats Everyone responds to stresswill differirritability, inability to concentrate, before sufferers do. It is also likely that when confronted, sufferers may deny go on the inmost serious calls may seemingly be who unaffected, lack ofSome interest who in activities, changes having these signs and symptoms. People are having serious problems briefingently. (CISD) while others have deep emotional reactions to not such calls. Seeking is not sleep patterns/nightmares, changes in with stress may be thinking clearly at care work, may not abe providing quality appetite, guilt, and isolation. carecan for patients, and may be putting sign of weakness. Many professionals help you dealpotentially with stress, andthemselves, much their patients, and their co-workers at risk. It is importantassistance that others act on that person’s behalf of the care may be covered stress by health insurance or employee proe different systems for preventing and if they do not go through what can be considered as a normal recovery process grams. stress and chronic stress, including wellness after experiencing a critical incident. This works well because feelings are

Signs and Symptoms of Stress

ventilated quickly. Always make sure that the environment is non-threatening. g, and peer support. Medical professionals A team of peer counselors est course of action for an EMT who is having and mental health professionals who help emergency care workers deal with critical incident stress. Meeting is held ll or experience is to seek help from a mental Stress management within 24 to 72 hours of a major incident. It is an Open discussion of feelings, ese issues. Everyone responds tonot stress differfears, and an increase investigation or interrogation; All information Inand your reactions diet, avoid fatty foods. Also, your carbohydrate intake while reducing your consumption of alcohol and seriousiscalls may seemingly be unaffected, caffeine. Exercise can helpleaders you burn off stress as well as deal better with the physical aspectsthe of work. Use deep-breathing confidential. CISD and mental health personnel evaluate inforl reactions to such isfamily not a exercises and calls. meditation to relax.care If your members have issues with your oddishours, long shifts, mation and offerSeeking suggestions on overcoming the stress. CISD Designed toworking weekends, holidays, birthdays, they worry about you getting hurt on the job, take time to discuss these concerns with them. nals can accelerate help youanddeal withorstress, and much theto normal process after those experiencing a working critical for incident. Have them talk the family recovery of other co-workers, especially who have been many years, and find out what ealth insurance or employee assistance proWorks well because feelings are ventilated quickly and Debriefing environcoping strategies they may have developed. request work shifts, allowing for more time to relax with family and friends. You may also opt for a rotation mentIfispossible, non-threatening. of duty assignment to a less busy area. If these do not work, seek professional help.

elors and mental health professionals who al with critical incident stress. Meeting is held Critical Incident Stress Debriefing (CISD) incident. It is an Open discussion of feelings, nvestigation or interrogation; All information Different EMS organizations have different systems for stress and dealing with critical incident stress and mental health personnel evaluate the infor-preventing chronic stress, including wellness incentives, professional overcoming the stress. CISD is Designed tocounseling, and peer support. rocess after experiencing a critical incident. Experts agree, however, that the best course of action for ventilated quickly and Debriefing environ-an EMT who is having significant stress from a serious call or

experience is to seek help from a mental health professional who treats these issues. Everyone responds to stress differently. Some who go on the most serious calls may seemingly be unaffected, while others have deep emotional reactions to such calls. Remember: Seeking help is not a sign of weakness. Many professionals can help you deal with stress. You may also consider what we call as Critical Indicident Stress Debriefing. Here, a meeting is called within 24 to 72 hours of a major incident. The meeting will be an open discussion of feelings, fears, and reactions -- not an investigation or interrogation; All information is considered confidential. Whatever insights are derived from the meeting are considered to facilitate smooth recovery of the EMT concerned. The process is designed to accelerate the normal recovery of the EMT after experiencing a critical incident. It works well because feelings are ventilated quickly. One important note: Make sure the debriefing environment is non-threatening.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

LIFELINE

PREHOSPITAL EMERGENCY CARE

² Limmer (Brady) ³ Pollack, (AAOS) 4 NHTSA

EMOTIONAL ASPECTS OF EMERGENCY CARE LEARNING OBJECTIVES

INTRODUCTION Death and dying These are inevitable hurdles in an EMS career. Members of the dead person’s family will respond in many different ways, including directing their grief, anger, and frustration at you as an EMT.

Stages Denial puts off dealing with death. Anger is commonly vented at family and EMS personnel. Bargaining postpones death, even for a short time. Depression is about mourning things not done, and is the patient’s retreat into his or her own world. Acceptance for the patient may come before acceptance for family members. Not all patients will progress through all stages, or in the same order. The dying patient’s family will often go through the same stages. (“Not me!”)

Denial

• Discuss the possible reactions that a relative may react when confronted with death and dying of family members

May dalawang klase ng stress. 1. Eustress ang tawag sa positibong uri ng stress. Tumutulong ito upang ang isang EMT ay makapagtrabaho at mas maging mahusay habang napi-pressure. 2. Distress naman ang tawag sa negatibong uri ng stress. Nakakasira ito ng diskarte ng isang EMT dahil nagiging magulo ang kanyang pag-iisip at pagdedesisyon.

(“Okay, but I haven’t…”) (“Why me?”)

Anger (“Okay, but first let me…”)

Bargaining

Depression (“Okay, I’m not afraid.”)

Acceptance

Dealing with the dying patient and family members Never say, “It will be okay,” because that is not certain. An honest statement is, “I will do everything I can to help you.” The patient’s needs include dignity, respect, sharing, communication, privacy and control. Family members may express rage, anger and despair. It is best to listen empathetically. Do not falsely reassure. Use a gentle tone of voice and use a reassuring touch, if appropriate. LIFELINE

PREHOSPITAL EMERGENCY CARE

DAY 2 EMTS Physical Well being THE WELL-BEING OF THE EMT Day 2 Personal Traits of a Good EMT

The EMT’s Physical Well-being You should be fit to carry out your duties. If you are physically un-

able to provide needed care, then all your training may be worthless to the patient. Practice with other EMTs is essential so that you can carry your share of the combined weight the out patient and Ifall Coordination and Malakas na You should be fit of to carry your duties. youequipment. are physically unable to are needed, as then well. will have perform basic rescue procepangangatawan ang dexterity provide needed care, all You your training will beto worthless to the patient. pangunahing kailangandures, lower Practice with other and EMTspatients is essential from so that upper you can carry your sharenegotiate of the stretchers levels, and fire esupang maging mahusaycapes and combined weight of the patient and all equipment. Coordination and dexterity stairways. You must be able to see distant objects as well as those na EMT. Kailangan kaya are needed, as well. You will have to perform basic rescue procedures, lower close at hand. Color important toand driving as fire well as patient assessment. UNIT mong buhatin ang mga stretchers and vision patients is from upper levels, negotiate escapes and stairways. Color of the skin,belips, and nail beds valuable clues to the pagamit para mailigtas ang You must able to see distant objectsoften as well provides as those close at hand. Color vision DAY pasyente. Kailangan ding is importantYou to driving wellgive as patient Color and of the written skin, lips, and tient’s condition. haveasto andassessment. receive oral instructions malinaw ang iyong mgaand communicate nail beds often provides valuablebystanders, clues to the patient’s You have toof the EMS with patients, and condition. other members mata, matalas ang iyong give and receive oral and written instructions and communicate with patients, and speech aresystem. important; problems mga tenga, at malinaw system. Eyesight, bystanders, hearing, and other members of the EMS Eyesight,any hearing, and speechmust be Physical Well being corrected. ang iyong pagsasalita dahil are important; any problems must be corrected.

Personal Traits of a Good EMT

FOUNDATION OF EMT PRACTICE

MTS

magbibigay ka ng direksyon • Pleasant to inspire confidence and sa mga kasamahan mo o sa ersonal Traits of a Good EMT help calm the sick and injured. pasyente. Mahalaga rin na • Sincere to convey an understankalmado ang isang EMT, Youmalumanay should be fit to at carry out your duties. If you are physically un-ding of the situation and the magsalita handang makipagtulungan le to provide needed care, then all your training may be worthless to thepatient’s feelings. • Cooperative to allow for faster sa kanyang grupo.EMTs At tient. Practice with other is essential so that you can carry your share and better care, establish better higit sa lahat, importante the combined weight of theatpatient and all equipment. Coordination andcoordination with other members na maging maparaan xterity are needed, You will have to perform basic rescue proce-of the EMS system, and bolster madiskarteas angwell. isang EMT para magampanan niya ang from upper levels, and negotiate fire es-the confidence of patients and res, lower stretchers and patients kanyang tungkulin kahit pes and stairways. You must be able to see distant objects as well as thosebystanders. • Resourceful to be able to adapt a anumang mangyari. se at hand. Color vision is important to driving as well as patient assessment. tool or technique to fit an unusual lor of the skin, lips, and nail beds often provides valuable clues to the pa-situation. nt’s condition. You have to give and receive oral and written instructions • Self-starter to show initiative and d communicate with patients, bystanders, and other members of the EMSaccomplish what must be done tem. Eyesight, hearing, and speech are important; any problems must bewithout having to depend on someone else to start procedures. rrected. • Emotionally stable to help overcome the unpleasant aspects of emergency so that needed care  Pleasant to inspire confidence and helpan calm the sick and injured. may be rendered and any uneasy  Sincere to convey an understanding feelings of thethat situation and the patient’s exist afterward may be resolved. feelings. • Nonjudgmental and fair treating  Cooperative to allow for faster and better care, establish better all patients equally regardless of coordination with other members of the EMS system, and bolster the confirace, religion, or culture. There are many cultural differences you will dence of patients and bystanders. encounter among patients.  Resourceful to be able to adapt a •tool fit the an unusual Ableorto technique lead in order tototake situation. steps necessary to control a scene, organize bystanders, deliver  Self starter to show initiative and accomplish what must be done with-

out having to depend on someone else to start procedures.  Emotionally stable to help overcome the unpleasant aspects of an emergency so that needed care may be rendered and any uneasy feelings that exist afterward may be resolved.  Nonjudgmental and fair treating all patients equally regardless of race, 72 LIFELINE PREHOSPITAL EMERGENCY CARE religion, or culture. are many cultural differences you will encoun Pleasant to inspire confidence and help calm the sick There and injured. ter among  Sincere to convey an understanding of thepatients. situation and the patient’s  Able to lead in order to take the steps necessary to control a scene, feelings. organize deliver emergency care, and when necessary, to  Cooperative to allow for faster and better bystanders, care, establish better coordi-

1 2

UNIT 1 DAY 2

•

emergency care, and when necessary, to take charge. Neat and clean to promote confidence in both patients and bystanders and to reduce the possibility of contamination. Of good moral character and respectful of others to allow for trust in situations when the patient cannot protect his own body or valuables and so that all information relayed is truthful and reliable. In control of personal habits to reduce the possibility of rendering improper care and to prevent patient discomfort. This includes never consuming  alcohol within eight hours of duty and not smoking when providing care. (Smoking can  contaminate wounds and is dangerous around oxygen delivery systems.) Controlled in conversation and  able to communicate properly in order to inspire confidence and avoid inappropriate conversation that may upset or anger the patient or bystanders or violate patient confidentiality.  Able to listen to others to be compassionate and empathetic, to be accurate with interviews, and to inspire confidence.

FOUNDATION OF EMT PRACTICE

Ang pag-aaral at pagsasanay ay hindi natatapos kahit pa makagraduate na sa EMT-Basic ang isang EMT. Mahalaga ang patuloy na pagbabasa at pagpapraktis. Mahalaga rin ang pagkuha ng mga refresher courses kada dalawa hanggang apat na taon para manatiling sariwa ang kaalaman ng Neat and clean to promote confidence in both patients and bystanders isang EMT. Sa patuloy and to reduce the possibility of contamination. na pag-aaral, higit na huhusay angtoisang EMTfor trust in Of good moral character and respectful of others allow at mas madali niyang situations when the patient cannot protect his own body magagampanan ang or valuables and so that all information relayed is truthful and reliable. kanyang tungkulin.

FOUNDATION OF EMT PRACTICE •

In control of personal habits to reduce the possibility of rendering improper care and to prevent patient discomfort. This includes never consuming alcohol within eight hours of duty and not smoking when providing care. (Smoking can contaminate wounds and is dangerous around oxygen delivery systems.) Controlled in conversation and able to communicate properly in order • to inspire confidence and avoid inappropriate conversation that may upset or anger the patient or bystanders or violate patient confidentiality.  Able to listen to others to be compassionate and empathetic, to be accurate with interviews, and to inspire confidence. Neat and clean to promote confidence in both patients and bystanders As an EMT, you must maintain up-to-date knowledge and skills. and to reduce the possibility of contamination. Education, for you, must be a constant process that extends long past Of good andReading respectful others allow for trust in knowledge and skills. Education yourmoral Lifelinecharacter Academy course. professional journals and AnofEMT musttomaintain up-to-date situations when the patientiswill cannot his of own body or long valuables joining EMS organizations youprotect keep abreast changes in the a help constant process that extends past the original EMT course. Reading research in emergency care causes occasional changes in and sofield. thatOngoing all information relayed is truthful and reliable. professional journals and joining EMS organizations will help you keep abreast procedure, so some of the information you are studying right now will In control of personal habits to reduce the possibility of rendering imof changes in the field. Ongoing research in emergency care causes occasional become outdated. Most areas require regular re-certification. Refresher propercourses care and tomaterial prevent patient discomfort. This conin procedure, soincludes some of never the information you are studying to become present to changes you as an EMT who has already been through a full course within but needseight to receive updated information. Get smoking refresher Most suming alcohol of and not when pro-require regular recertification. Reanhours EMT willduty become outdated. areas two- to four-year intervals. Continuing education supplements courses present material the EMT who has already been through a vidingcourses care.at(Smoking canfresher contaminate wounds and is todangerous the original course. For example, you may wish to learn more about course but needs receive around oxygen delivery systems.) pediatric or trauma skills orfull driving techniques. You canto obtain this updated information. Refresher courses are required at twoto four-year intervals. education supplements the education in conferences and seminars, videos, or demonstrations. Controlled in conversation and able to communicate properly in Continuing order original course. For example, you may wish to learn more about pediatric or to inspire confidence and avoid inappropriate conversation that may skills orordriving You can obtain this education in conferupset or anger the patient trauma or bystanders violate techniques. patient confidentialences and seminars and through lectures, classes, videos, or demonstrations. ity. 73 PREHOSPITAL EMERGENCY CARE Able to listen to others to be compassionate and empathetic, to be LIFELINE accurate with interviews, and to inspire confidence. •

  



UNIT 1 DAY 2

Day 2

FOUNDATION OF EMT PRACTICE

THE WELL-BEING OF THE EMT

CRITICAL CONCEPTS A sample quality improvement review might go asCRITICAL follows: CONCEPTS

Exposure to Infectious Diseases Exposure to Infectious Diseases Communicable diseases Infectious Diseases Risk Reduction and prevention for Infectious and - This

Infectious Diseases - is a medical bythat thecan growth is a medical condition causedcondition This is caused a disease spread and spread of small, harmful body. Communicable by the growthorganisms and spreadwithin of the from one person or speciesdisto eases - a disease that can spread organisms from one person another. or species to another. small, harmful

As part ofAa sample continuous quality improvement review mightthe go Quality as follows: review of calls, Improvement (QI) committee within the body. As part of a continuous review of has reviewed all of your squad’s calls, the Quality Improvement (01) run reports that involve committee has reviewed all of your Communicable Diseases squad's run reports that involve trauma during one particular 1. Standard Precautions trauma duringhas one particular month. The committee 2. Recommendation—Proper hand hygiene month. The committee has noted noted that time spent at the 3. Personal Protective Equipment Chat the lime spent at the scene of scene of serious serioustrauma traumacalls calls was excessive.  Gloves was excessive. (You You will will learnlater later (hat lime 1. at Standard the Precautions  Gowns (in special cases) 4. Patient Care Environment learn that scene time atoftheserious scene trauma should be • Soiled patient Care Equipment  Mask, eye protection, face shield to should a minimum, of serious kept trauma be because the in• Environmental Controls jured patient must be transported to 4. Patient Care Environment 2. Recommendation—Proper hand hygiene kept to a minimum because the hospital for care that cannot be  Soiled patient Care Equipment• Textiles and Laundry the injuredprovided patient must in the be field.) • Needles and other sharp objects Environmental Controls transported to the hospital for 3. Personal Protective Equipment care that cannot be provided in  Textiles and Laundry • Gloves 5. Special Circumstances the field. Needles and other sharp objects • Gowns (in specialcases) • Patient Resuscitation 5. Special Circumstances • Mask, eye protection, face shield • Respiratory hygiene / cough eti Patient Resuscitation quette  Respiratory hygiene / cough etiquette Upang higit na humusay ang isang EMT, Quality improvement mahalaga ang Quality A system of internal/external reviews and audits of all aspects of an EMS Improvement. Sinusuri system so as to identify those aspects needing improvement assureofthat the public A system of internal/external reviews andtoaudits all aspects of an dito ang log book ng EMT receives the prehospital EMShighest system quality so as toof identify those care. aspects needing improvement to assure that at inaalam kung paano the public receives the highest quality of prehospital care. nito ginawa ang kanyang tungkulin at kung gaano The role of the EMT-Basic in quality improvement kabilis. Sa pamamagitan 1. Documentation ng Quality Improvement 2. Run reviews and audits ay mas magiging epektibo 1. Documentation 3. Gathering feedback from pa“ ang serbisyong igagawad ng 2. Run reviews and audits tients and hospital staff isang EMT. 3. Gathering feedback from patients and hospital staff 4. Conducting preventative main4. Conducting preventative maintenance tenance 5. Continuing education 5. Continuing education 6. Skill maintenance 6. Skill maintenance

Risk Reduction and Prevention for Infectious and Communicable Diseases

Quality improvement

Your role as an EMT in quality improvement

Medical direction

Types of medical direction

A physician responsible for the clinical and patient care aspects of an EMS system and Responsible for reviewing quality improvement. Every amA physician Offline medical control involves bulance service/rescue squad must have physician medical direction. responsible for the clinical policies or protocols that authorize

and patient care aspects of an EMT to perform particular Types direction an EMS of andmedical responsible skills in certain situations. Online for reviewing quality medical control involves requesting or protocols authorimprovement.Off-line Every medical control involves orders policies from medical controlthat (usually ize an EMT to perform particular skills inby certain medical conambulance service/rescue radio situations. or phone) On-line or getting requesting medical by control (usually radio or trol involves squad must have physicianorders from approval medical controlbybefore phone) or getting approval by medicalperforming control before performing certain promedical direction. certain procedures. cedures.

LIFELINE

PREHOSPITAL EMERGENCY CARE

² Limmer (Brady)² Limmer (Brady) (AAOS) ³ Pollack, (AAOS)⁴³ Pollack, NHTSA 4 NHTSA

INTRODUCTION TO EMS MEDICAL, LEGAL AND ETHICAL ISSUES UNIT 1 DAY 2

LEARNING OBJECTIVES KEY TERMS

 Legal- conforming to or permitted by

or established •lawDefine therules scope of practice of the EMS  Ethics—an area of study that deals profession. with ideas about what is good and behaviour : the a branch of philoso•badDiscuss phy dealing with what is morally importance of Do right or wrong Not Resuscitate and local provisions  Moral—considered right andand good by most people : agreeing with a stanregulations. dard of right behaviour • Define the term consent. • Discuss the differences and methods of obtaining each consent.

Scope of Practice

FOUNDATION OF EMT PRACTICE

INTRODUCTION TO EMS MEDICAL, INTRODUCTION LEGAL AND ETHICAL ISSUES

The EMS profession is governed by many

LEARNING OBJECTIVES medical, legal, and ethical guidelines. This set of

KEY TERMS � Legal — conforming to or permitted by law or established rules � Ethics — an area of study that deals with ideas about what is good and bad behaviour : a branch of philosophy dealing with what is morally right or wrong � Moral — considered right and good by most people : agreeing with a standard of right behaviour

regulations and ethical considerations may be

● Define the scope of practice of the EMT-Basic referred to as a scope practice, which defines directives) the ● Discuss the importance of Doof Not Resuscitate [DNR] (advance and local provisions and regulations regarding system. extent and limits of your job as anEMS EMT. The skills ● Define the term consent. Discuss the differences and methods of obtainand medical interventions which you would do to ing each consent.

help the patient are defined by legislation and may vary depending on culture, religion and from region INTRODUCTION to region.

Ang propesyon ng EMT ay may mga sinusunod na pamantayan. Nandyan ang pamantayang medikal, legal at ethical. Mahalaga na malaman ng isang EMT ang mga pamantayan na ito upang makaiwas ito sa problema.

EMTs are governed by many medical, legal, and ethical guidelines. This set of regulations and ethical considerations may be referred to as a scope of practice, which defines the extent and limits of an EMT’s job. The skills and medical interventions (what you do to help the patient) the EMT may perform are defined by legislation, which varies from state to state. Sometimes different regions within the same state may have and guidelines. a. different Make rules the physical and

1. Legal duties to the patient, medical “ director, and the public

2. Ethical responsibilities

emotional needs of the Scope ofpatient Practiceby a. Provide for the well-being of the patient a priority. rendering necessary interventions` 1. Legal duties outlined to the patient, medicalb. director, and public Practice/maintenance of a. Provide for the well-being of the patient by rendering necessary interin the scope of practice. skills to the point of mastery. ventions outlined in the scope of practice. b. Defined by legislation b. Defined by state legislation c. Attend continuing i. Enhanced by medical direction i. Enhanced by medical direction through the use of protocols and education/refresher through the use of protocols standing and orders. programs. ii. Referenced to the National Standard Curricula standing orders. c. Legal right to function as an EMT-Basic may be contingent d. Critically review upon medial direction. performances, seeking i. Telephone/radio communications. c. Legal right to function as an EMT depends ii. Approved standing orders/protocols ways to improve response upon the approval of medial direction. iii. Responsibility to medical direction time, patient outcome, 2. Ethical responsibilities i. Telephone/radio communications. a. Make the physical/emotional needscommunication. of the patient a priority. ii. Approved standing orders/protocols b. Practice/maintenance of skills to point of mastery. e. theHonesty in reporting. c. Attend continuing education/refresher programs. iii. Responsibility to medical direction d. Critically review performances, seeking ways to improve response time, patient outcome, communication. e. Honesty in reporting

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

LIFELINE

PREHOSPITAL EMERGENCY CARE

UNIT 1 DAY 2

FOUNDATION OF EMT PRACTICE Day 2

MEDICAL, LEGAL AND ETHICAL ISSUES

Standards of Care - defines the care that one would expect another EMT with similar training to provide when caring a care patient inwould a similar Standards of Care - These referfor to the that one expectsituation. from another EMT with similar training to provide to a patient in a similar situation.

EMS Standards of Care

a. Standards by Local Custom EMSimposed Standards of Care b. Standardsa.imposed by Law Standards imposed by local custom c. Professional or Institutional Napakaimportante na b. Standards imposed byStandards law makuha ng isang EMT Professional institutional standards d. Standard c. imposed byorTextbooks ang consent o pagpayag d. Standard by imposed by textbooks e. Standard imposed states ng isang pasyente. Kung

e. Standard imposed by authorities posible, dapat kunin ng EMT ang hayagang pagpayag o expressed consent mula sa pasyente Ethics are not always driven by law. Often they are a way of governing actions o sa pamilya nito bago ito that treats others as we would wish to be treated ourselves. EMTs are often placed in bigyan ng anumang lunas. situations where they must decide what the right thing to do is, and laws and policies Ayon sa batas, puwedeng may not give the guidance needed. Ethics magbigay ng lunas ang are not always driven by law. Often they are a way of governing actions isang EMT kung walang EXPRESSED Thistreated must be informed consent.EMTs Patientsare mustoften that treats others as1.we wouldCONSENT wish to- be ourselves. malay ang pasyente o understand themust risks associated with the the care they willthing receive.to It isdo notis, only a placed in situations where they decide what right and hanggang sa magkaroon ito legal requirement but also sound emotional care to explain all procedures to laws and policies maythe not giveItthe needed. ng malay at alam na nito patient. mustguidance be obtained from all conscious, mentally competent adult ang kanyang ginagawa. patients prior to providing care. In the case of an unconscious patient (or one Nagkakaproblema lamang who may be physically mentally incapacitated), maymust be assumed 1. Expressed Consent - must beorinformed consent. consent Patients underang EMT kung ang isang or implied. The law states that rational patients would consent to treatment if stand the risks associated with will receive. It is not pasyente ay tumanggi they were conscious. The law the allowscare EMTs they and other health care providers to na bigyan siya ng tulong treatment,but at least untilsound the patient become conscious andexplain able to make only a legal provide requirement also emotional care to all medikal. A common scenario is a diabetic patient more procedures rational to thedecisions. patient. It must be obtained from who all becomes conscious, alert after receiving oral glucose. This may be a concern if the patient wishes to mentally competent patients prior to providing care. In the refuse furtheradult treatment. IMPLIED CONSENT - Consent from the unconscious patient case of an2. unconscious patient (orassumed one who may be physically or requiring emergency intervention. It isbe basedassumed on the assumption that the The mentally incapacitated), consent may or implied. unconscious patient would consent to life saving interventions law states 3.that rational patients would consent to treatment if they MENTALLY INCOMPETENT INDIVIDUALS - Consent for Emergency Care of mentally individuals be obtained from someone who is were conscious. Theincompetent law allows EMTs should and other health care providlegally responsible for patient. A prisoner who is conscious andconscious capable of ers to provide treatment, at the least until the patient become making decisions does not surrender the right to make medical decisions and and able to may make rational decisions. A common scenario is a diabetic refuse care.

Ethics

patient who becomes more alert after receiving oral glucose. This may be a concern if the patient wishes to refuse further treatment.

Children and consent

on from the other action by

2. Implied Consent - Consent assumed from the unconscious patient Parents and guardians of childrenIthave the legal on authority give consent, sothat it requiring emergency intervention. is Based the to assumption must be obtained before care can be given. Care may be given without direct consent the unconscious patient would consent to life saving interventions from a parent or guardian in some cases: In loco parentis. A child care provider or

school authority may act in loco parentis, or in place of the parents. Parents may provide

documentation toCare these individuals allowingincompetent them to act in theirindividuals absence. 3. Consent written for Emergency of mentally Emancipated minors. In some states, statutes allow emancipated minorsâ&#x20AC;&#x201D;those who are should be obtained from someone who is legally responsible for the married or of a certain ageâ&#x20AC;&#x201D;to provide consent. Life-threatening illness or injury. The patient. law provides that it is reasonable to believe that a responsible parent or guardian would consent to care if present. Minors who have children and minors serving in the armed forces may also be able toand provide consent forof their own care.decisions does not who is conscious capable making

A prisoner surrender the right to make medical decisions and may refuse care. 76

LIFELINE

PREHOSPITAL EMERGENCY CARE

Children and consent Parents and guardians of children have the legal authority to give consent, so it must be obtained before care can be given. Care may be given without direct consent from a parent or guardian in some

Refusals • The patient has the right to refuse treatment. • The patient may withdraw from treatment at any time. Example: An unconscious patient regains consciousness and refuses transport to the hospital. • Refusals must be made by mentally competent adults following the rules of expressed consent. • The patient must be informed of and fully understand all the risks and consequences associated with refusal of treatment/transport, and must sign a “release from liability” form. • When in doubt, err in favor of providing care. • Documentation is a key factor to protect an EMT in case of refusal. Competent adult patients have the right to refuse treatment. Before the EMT-Basic leaves the scene, he should: 1. Try again to persuade the patient to go to the hospital; 2. Ensure the patient is able to make a rational and informed decision, e.g., not under the influence of alcohol, drugs, or illness/injury effects; 3. Inform the patient why he should go and what may happen to him if he does not; 4. Consult medical direction as directed by local protocol; 5. Consider assistance of law enforcement; 6. Document any assessment findings and emergency medical care given, and if the patient still refuses, then have the patient sign a Refusal Form. As an EMT, you should never make an independent decision not to transport.

Other Legal Issues—Advance Directives Do Not Resuscitate (DNR) orders A DNR is often present for a patient with a documented terminal illness who does not wish to prolong life through resuscitative efforts. It is usually signed by both the patient (or health care proxy or surrogate) and the patient’s physician. A DNR’s instructions may stipulate when to and when not to resuscitate. Anyone— with or without health problems—can have a living will. The living will may state that if the patient is in a permanent state that requires being kept alive artificially (ventilator, feeding tube, etc.), the patient does not wish to be kept alive. If a patient with a living will goes into cardiac or respiratory arrest, the patient should be treated. If, however, as a result of the arrest the patient suffers permanent brain damage and must have a ventilator to stay alive, then the living will comes into play. A health care proxy is a person whom the patient names to make health care decisions if the patient is unable. This usually deals with long-term life support and comfort measures (respirators, IV feedings, pain medications), and is most likely to affect care in hospital rather than pre-hospital situations. The existence of a DNR or living will does not prevent the EMT from providing comfort measures such as oxygen, positioning, or other treatment.

Ang isang pasyente na nasa tamang edad at tamang pag-iisip ay maaaring tumanggi na bigyan ng tulong ng isang EMT. Pero bago siya iwan ng EMT, kailangan subukin ng EMT na kumbinsihin siyang magpunta sa ospital at seguruhin na alam niya ang kanyang ginagawa at hindi ito lasing o nasa ilalim ng impluwensya ng droga. Kailangan ding humingi ng tulong sa mga alagad ng batas. Kung hindi pa rin talaga payag ang pasyente, kailangan itong papirmahin sa isang Refusal Form. Huwag na huwag gumawa ng sariling desisyon na hindi tulungan ang pasyente.

Living Will There are cases when the patient has an advance medical directive that specifies what types of medical treatment are desired. A living will can be very specific or very general. The most common statement in a living will requests that if the patient suffers an incurable, irreversible illness, disease, or condition, and the attending physician determines that the condition is terminal, lifesustaining measures that would serve only to prolong dying should be withheld or discontinued. More specific living wills may include information regarding an individual’s desire for services such as pain relief, antibiotics, hydration, feeding, and the use of ventilators, blood products, or cardiopulmonary resuscitation. LIFELINE

PREHOSPITAL EMERGENCY CARE

Day 2

Ang Revised Penal Code ay nagbibigay parusa sa sinuman na hindi tutulong sa taong nadisgrasya, sugatan at maaaaring mamatay. Pero hindi kagaya sa ibang bansa, walang Good Samaritan Law sa Pilipinas. Ang ibig sabihin nito, walang proteksyon ang sinuman na magbibigay ng tulong sa isang taong nasa bingit ng kamatayan sakaling ito ay magsabi na ang kanyang karapatan ay inabuso ng tumulong sa kanya. Merong mga batas na nakasalang ngayon sa Senado na may tawag na Good Samaritan Act subalit ang mga ito ay tumutukoy lamang sa donasyong medikal o donasyong pagkain at hindi sa pagtulong sa mga sugatan o biktima ng aksidente.

MEDICAL, LEGAL AND ETHICAL ISSUES

Health care proxy An advance medical directive in the form of a legal document that designates another person (a proxy) to make health care decisions in case a person is rendered incapable of making his or her wishes known. The health care proxy has, in essence, the same rights to request or refuse treatment that the person would have if he or she were capable of making and communicating decisions.

Duty to act Duty to act is the obligation that requires patient care on the part of the EMT. Abroad, Good Samaritan laws protect well-intended providers when no duty to act exists. In the Philippines, the Revised Penal Code requires anyone who sees a victim of accident and in danger of dying to provide assistance. However, such the law does not protect the person who gives the assistance from any liability that he may incur in providing such help. Ther is now a pending bill in Senate that is called Good Samaritan Act. It pertains to donations made in the form of food or medicines that will be exempted from taxes.

Negligence This refers to deviation from the accepted standard of care resulting in further injury to the patient. Negligence in EMS implies that there was a duty to act but that there was a breach of duty or a breach of the standard of care. It also implies that damages occurred as a result. Negligence is the basis for many of the lawsuits involving prehospital emergency care. An example of proximate causation would be injuries caused if EMTs dropped the stretcher carrying a patient. This concept cannot be applied to patients who are seriously injured and cannot be saved. If you perform CPR according to guidelines and the patient dies, there is no proximate causation. The components of negligence are as follows: Duty to act, breach of the duty, injury/ damages were inflicted. If negligence is proven, the EMT may be required to pay for medical expenses, lost wages (possibly including future earnings), pain and suffering, and various other factors as determined by the court. The proceedings or lawsuits against EMTs are usually classified as torts, or civil offenses as opposed to a criminal offense resulting in arrest.

Abandonment Ths is the termination of care of the patient without assuring the continuation of care at the same level or higher. If an EMT has initiated care, then leaves a patient without ensuring that the patient has been turned over to someone with equal or greater medical training, abandonment exists.

Assault/Battery Unlawfully touching a patient without his consent. Providing emergency care when the patient does not consent to the treatment

Good Samaritan Law

In other countries, there exists a law called Good Samaritan Law that provides immunity to individuals trying to help people in emergencies. This law grants immunity from liability if the rescuer acts in good faith to provide care to his or her level of training and ability. Unfortunately, as mentioned earlier, such a law does not yet exist in the Philippines. On the contrary, Article 275 of the Revised Penal Code penalizes anyone who abandons a person who is at risk of dying in an uninhabited place. It mandates a witnessing person to assist the injured victim, but it does not provide immunity from suit to the assisting person. An EMT should familiarize himself with the law and its boundaries. 78

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Records and Reports â&#x20AC;&#x201C; Confidentiality Under the Data Privacy Act of 2012, any information you obtain about a patientâ&#x20AC;&#x2122;s history, condition, or treatment is considered confidential and must not be shared with anyone else. This principle is known as confidentiality. Such information may be disclosed only when a written release is signed by the patient. Lifeline has a strict policy on this. Patient information should not be disclosed based on verbal permission, nor should information be disclosed over the telephone. You may be subpoenaed, or ordered into court by a legal authority, where you may legally disclose patient information. If you have a question about the validity of a legal document, contact a supervisor or your agencyâ&#x20AC;&#x2122;s attorney for advice.

Releasing confidential information - Requires a written release form signed

by the patient. Do not release on request, written or verbal, unless legal guardianship has been established. A release is not required under the following circumstances: 1. When other health care providers need to know information to continue care. 2. When the law requires reporting incidents such as rape, abuse or gunshot wounds. 3. In third party payment billing forms. 4. When there is legal subpoena.

Anumang impormasyon ang kunin mo sa pasyente ay kailangang manatiling confidential. Huwag na huwag mong ipapaalam ito sa iba nang wala siyang pahintulot. Ito ang principle of confidentiality. Ang Lifeline Rescue ay may malinaw na policy patungkol dito. Hindi puwedeng ilabas ang impormasyon tungkol sa pasyente kung ang pahintulot ay sinabi lamang o ibinigay lamang sa telepono. Kailangan nakasulat ang pahintulot. Kung may katanungan patungkol sa legalidad ng isang dokumento, magtanong sa iyong supervisor o sa inyong abogado.

Donor/organ harvesting consideration This requires a signed legal permission document such as a donor card and intent to be a donor. A potential organ donor should not be treated differently from any other patient requesting treatment.

Your role in organ harvesting 1. 2. 3. 4.

Identify the patient as a potential donor. Establish communication with medical direction. Provide care to maintain viable organs. Medical identification insignia a. Bracelet, necklace, card b. Indicates a serious medical condition of the patient (allergies, diabetes, epilepsy, etc.)

LIFELINE

PREHOSPITAL EMERGENCY CARE

nterestingly enough, police arc often as unfamiliar with EMS procedures as you arc with police evidence procedures. The police may ask you to deay your work at the scene so ihcy can ake photographs or inter, lew the patient They may do this hecausc they CRITICAL CONCEPTS do not understand—as you will learn n later chapters—that in the case of erious injury,It isthe lime that elapses interesting to note before on-sccne and are transport that care the police often to as unfamiliar withto EMS he hospital must be kept a miniyou are mum for the procedures patient toashave thewith best police evidence procedures. chance of survival. Education and may ask you to critiques canThe bepolice beneficial lo both delayofficers. your work at the scene EMTs and police so they can take photographs or interview the patient. They may do this because they do not understand -- as you learn in later chapters -- that in the case of serious injury, the time that elapses before on-scene care and transport to the hospital must be to a minimum for the patient to have the best chance of survival. Education and critiques can be beneficial to both EMTs and police officers. Kadalasan, hindi pamilyar ang mga pulis sa trabaho ng mga EMTs at hindi rin pamilyar ang mga EMTs sa trabaho ng mga pulis. May mga pagkakataon na makikiusap ang mga pulis na huwag muna dalhin ang isang pasyente dahil kailangan pa nilang kunan ito ng litrato o interbiyuhin. Lingid sa kaalaman nila, mahalaga na madala sa ospital ang isang pasyente upang tumaas ang tsansa na mabuhay ito. Ang bawat segundo ay mahalaga para sa EMTs, kaya dapat din na ipaliwanag ito sa mga pulis na nasa crime scene.

“

DAY 2 LEARNING OBJECTIVES

LEGAL AND ETHICAL ISSUES ● Discuss considerations of the EMT-Basic in issues of organ preservation Day 2 the MEDICAL, and retrieval. ● Classify the actions that an EMT-Basic should do to achieve the preservation of a crime scene. ● Discuss the situations that require an EMT-Basic to inform local law enforcement officials.

POTENTIAL CRIME SCENE/EVIDENCE PRESERVATION

INTRODUCTION

INTRODUCTION LEARNING Crime scenes present a special challenge to EMTs. The patient must be cared for, but steps also must be taken to preserve evidence. The DisOBJECTIVES patch should notify police personnel. Crime scenes present a special challenge to EMTs. The patient must be cared for, but steps also must be taken to preserve evidence. The Dispatch should notify police personnel.

Responsibility of the EMT-Basic • Discuss the considerations of

Responsibility of the EMT

a. Emergency careofof the patient is the EMT-Basic's priority. the EMS in issues organ preservation b. Do not disturb any item at the scene unless emergency care requires it. a. Emergency care of the patient is and retrieval. c. Observe and document anything unusual at the scene. your priority as an EMT. • Classify the actions d. If possible, do not cut through holes in clothing b. Do not disturb any item atfrom the gunshot wounds that an EMT should or stabbings. scene unless emergency care do to achieve the

requires it. preservation of a c. Observe and document crime scene. Examples of Evidence anything unusual at the scene. • Discuss the situations d. If possible, do not cut through that require an EMT Condition scene you in find the from scene is important evidence. clothing gunshot to informof local law . The way holes Should you arrive first, make a mental note of the exterior and how wounds or stabbings. enforcement officials.

you gained access. Doors found ajar, pry marks, and broken windows are signs of danger for you and important evidence for police. Note whether lights, TV, and radio are on or off. The patient provides valuable information: position, condition of clothing, and injuries.

LIFELINE

PREHOSPITAL EMERGENCY CARE ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

FOUNDATION OF EMT PRACTICE Fingerprints and footprints are perhaps the most familiar kind of evidence.

They may be obtained from almost any surface. Avoid unnecessarily touching anything in order to preserve prints. If you touch these objects, even while wearing gloves, you may smudge fingerprints that were left by someone else.

Examples of Evidence Condition of scene.

The way you find the scene is important evidence.

Should you arrive first, make mentalrange note of of theevidence exterior andthat how is you gained invisible to Microscopic evidence is aawide usually

access. found ajar,such pry marks, andand broken windows are signs of danger for theDoors naked eye, as dirt carpet fibers. Under the microscope, you and important evidence for police. Note whether lights, TV, and radio are on scientists develop valuable information. Fromofjust a few fibers, or off. The patientcan provides valuable information: position, condition clothing, the materials and sometimes the brand name of carpets or clothes and injuries.

can be determined. of blood may be enough to determine Fingerprints and footprintsTraces are perhaps the most familiar kind of evidence.

or to bealmost usedany forsurface. DNA comparison. Theyblood may be type obtained from Avoid unnecessarily touching anything in order to preserve prints. If you touch these objects, even while wearing gloves, you may smudge fingerprints that were left by someone else.

Evidence Preservation Microscopic evidence is a wide range of evidence that is usually invisible to

the naked eye, such as dirt and carpet fibers. Under the microscope, scientists can develop valuable information. just a few to fibers, the materials and sometimes It may beFrom necessary move the patient or furniture to the brand name of carpets or clothes can be determined. Traces of blood may be but tell begin CPR or other patient care. This cannot be avoided, enough to determine blood type or to be used for DNA comparison.

police what you have touched or moved so they will not make incorrect assumptions. If you must move the patient or furniture to begin care, move as little as possible. Do not go to other areas unnecessarily. Avoid using the phone, as this will prevent using the redial button to determine who the victim called last. Do not use the bathItroom. may be Do necessary to move the patient or furniture to begin CPR other or knives. not cut through holes left in clothing by or bullets patient care. This cannot be avoided, but tell police what you have touched or Cut at least 6 inches from these holes. The police may require a statemoved so they will not make incorrect assumptions. If you must move the patient ment to about yourmove actions orasobservations scene. or furniture begin care, as little possible. Do notat go the to other areasWhile it may not be Avoid possible while patient is going on, after unnecessarily. usingto themake phone,notes as this will prevent using care the redial button to determine the at victim last. Do not use the bathroom. Do notobservations cut through you who arrive thecalled hospital make notes about your and holes actions left in clothing by bullets knives. arrival Cut at least from these at the scene.orUpon at six theinches hospital, youholes. may wish to The police may require a statement about your actions or observations at the scene. turn the stretcher sheet over to police personnel so it can be examWhile it may not be possible to make notes while patient care is going on, after you possible evidence. arriveined at thefor hospital make trace notes about your observations and actions at the scene.

Evidence Preservation

May mga pagkakataon na kailangan mong iusog ang pasyente o ang isang kasangkapan para makapagbigay ng CPR. Ito ay hindi maiiwasan. Sabihan mo na lamang ang mga pulis kung meron kang hinawakan o binago ng puwesto dahil makakaapekto ito sa paghahanap nila ng ebidensya. Huwag ka nang magpalibut-libot pa kung hindi naman kailangan. Huwag mo rin gamitin ang banyo at ang telepono ng pasyente. Kung may tama ng bala o saksak ng kutsilyo, huwag mong pakialaman ang butas na nilikha nito sa damit ng pasyente. Kung kailangan mong punitin ang damit ng pasyente, gawin mo ito nang may anim na pulgada mula sa butas na dinaanan ng bala. Kung meron kang napansin na kakaiba, ipagbigay-alam mo ito sa mga pulis matapos dalhin ang pasyente sa ospital.

Upon arrival at the hospital, you may wish to turn the stretcher sheet over to police personnel so it can be examined for possible trace evidence.

LIFELINE

PREHOSPITAL EMERGENCY CARE

LIFELINE PREHOSPITAL EMERGENCY CARE

MANY students often say, “I just want to be an ambulance crew, why do I need to study anatomy and physiology?” Simple: Because your role as a future Emergency Medical Technician (EMT) is to provide help to people who have been injured or ill. You will only be able to do so if you fully understand the human body and how it functions. Consider anatomy and physiology as the foundation for the house that you are about to build. The foundation is what you must construct first. A strong foundation will mean a strong house.

LIFELINE

PREHOSPITAL EMERGENCY CARE

DAY

Anatomy And Physiology Of The Human Body Directional and Positional Terms Muscular and Skeletal System Respiratory System Circulatory System Master anatomy and physiology and the rest of this course will be easy. Neglect these two topics and I assure you that the remaining parts of this course will be very hard. Once you move on from this to the other chapters, your instructor will assume that you have already understood basic anatomy and physiology. They will not make the effort to re-teach this material. It will be up to you to fill in any gaps that you may have. Thus, it is best to try to understand these topics as much as you can while you are here.

Nervous System Digestive System Reproductive System LIFELINE

PREHOSPITAL EMERGENCY CARE

Physiology ology – study – study of body of body func-funcANATOMY ANATOMY AND AND PHYSIOLOGY PHYSIOLOGY ion

DAY 3

Think Think of anatomy of anatomy and and physiology physiology as the as owner's the owner's manual manual to the to body. the body. When When a a mechanic mechanic works works on your on your car, car, he often he often refers refers to the to manual the manual to help to help him him belter belter FOUNDATION OF PRACTICE Daywhere 3 where understand understand the specific the specific partsparts are EMT placed are placed and and whatwhat those those partsparts do. As do.an As an CRITICAL CONCEPTS EMT.EMT. you you will use will ause knowledge a knowledge of The of The body’s body’s anatomy anatomy and and physiology physiology to better to better understand understand where where vital vital structures structures are located are located and and howhow injuries injuries and and illnesses illnesses will will Normal anatomical positionaffectaffect the body the body in general. in general. • Person standing, facing forward • Palms facing forward

KEY TERMS � Anatomy – This is the study of the body’s structure. � Physiology – This is the study of body’s functions.

THE HUMAN BODY’S ANATOMY AND PHYSIOLOGY

ANATOMICAL ANATOMICAL POSITION POSITION UNIT 1

DAY 3

“ Sa chapter na ito ay pag-aaralan natin ang katawan ng tao at kung papaano gumagana ang bawat bahagi nito. Matututunan mo kung ano ang mga katawagan na ginagamit para sa bahagi ng katawan gaya ng medial, lateral, proximal, distal, at iba pa. Malalaman mo rin kung ano ang iba’t ibang sistema sa katawan na sumasaklaw sa paghinga, pagdaloy ng dugo, pagkilos ng katawan at kung anuano pa.



FRONT

BACK

FRONT FRONT ANATOMICAL POSITION

BACK BACK

LEARNING OBJECTIVES

• Identify the topographic terms used in locating the structures of human body. These are medial, lateral, proximal, distal, superior, inferior, anterior, posterior, midline, right and left, mid-clavicular, bilateral and mid-axillary. • Describe the anatomy and function of the major body systems, namely the ² Limmer, ² Limmer, O’Keefe,O’Keefe, “Emergency “Emergency Care”, 12th Care”, Edition. 12th Edition. Brady, NJ Brady, (2012) NJ (2012) respiratory, circulatory, musculoskeletal, nervous endocrine. ³ Pollack,³ Pollack, “Emergency “Emergency Care and Care Transport and Transport of Sick and of Sick Injured”, and Injured”, 10th Edition. 10th Edition. AAOS, MS AAOS, (2011) MSand (2011)

⁴ National ⁴ National Highway Highway and Traffic andSafety TrafficAdministration Safety Administration (NHTSA), (NHTSA), “EMT Basic “EMT Standard Basic Standard Curriculum“, Curriculum“, Department Department of Transportation, of Transportation, USA, (2005) USA, (2005) ₅ ₅

INTRODUCTION

If you would treat your body as a machine, then consider anatomy and physiology as the operations and service manuals that guide you in the efficient use of such amazing contraption. You refer to these manuals to better understand where the specific parts are placed and what those parts are for. As an EMT. you will use the knowledge of the body’s anatomy and physiology to better understand where vital structures are located and how injuries and illnesses affect the body in general.

LIFELINE

PREHOSPITAL EMERGENCY CARE

NOTE: Most of the information in this chapter came from the 12th edition of the book “Emergency Care” by Daniel Limmer and Michael O’Keefe. Used with permission from the book’s publisher, Pearson Education, Inc.



FOUNDATION OF EMT PRACTICE

Anatomical terms Directional Terms • Midline -Imaginary line drawn vertically through the middle of the body: Nose to umbilicus (belly button); Divides the body into right and left.

FOUNDATION OF EMT PRACTICE

• Mid-axillary—Imaginary line drawn vertically from the middle of the armpit to the ankle; Divides the body into anterior and posterior. • The terms superior and inferior refer to vertical Two other terms you may sometimes hear are palmar [referring to the »or up-and-down, directions. Superior mean inferior means below. An example of this palm of the hand) and plantar (referring to the sole of above; the foot). would he, “The nose is superior to the mouth.

The mid-clavicular line divides the chest into regions. It runs through the • The terms proximal and distal are relative Proximal center of a clavicle (collarbone) and extends inferiorly.terms. Since theremeans arc closer twoto the torso (the trunk of the body, or the body without the head the extremities). Distal means farther away clavicles, there are two mid-clavicular lines. When youanduse a stethoscope from the torso. For example, think of an elbow. to listen for breath sounds, you will place the stethoscope the midIt is proximalat to the hand, because it is closer to the torso than the hand. The elbow also is distal clavicular lines to listen to each side of the chest and assess the function of is farther away lo the shoulder, since the elbow from the torso than the shoulder. The terms both lungs. arc usually used when describing locations on

extremities. For example, to be sure circulation has not been cut off after splinting an arm or leg. One must feel for a distal pulse. This is a pulse found in an extremity, a pulse point that Anatomical terms - Directional Terms is farther away from the torso than the splint. When using relative terms like proximal and  Midline -Imaginary line drawn vertically through the middle of theit is helpful to give a point of reference. distal, Forand example, you might say a laceration is body: Nose to umbilicus (belly button); Divides the body into right proximal to the elbow. In this case, the elbow is left. your point of reference.

Anatomical Planes

 



Mid-axillary—Imaginary line drawn vertically from the middle of the • Two other terms you may sometimes hear are armpit to the ankle; Divides the body into anterior and posterior. palmar [referring to the palm of the hand) and The terms superior and inferior refer to vertical »or up-and-down,plantar direc- (referring to the sole of the foot). tions. Superior mean above; inferior means below. An example • of Thethis mid-clavicular line divides the chest into regions. It runs through the center of a clavicle would he, "The nose is superior to the mouth.

(collarbone) and extends inferiorly. Since there

The terms proximal and distal: relative terms. Proximal means closer to clavicles, there are two mid-clavicular arc two lines. When you use a stethoscope to listen for the torso (the trunk of the body, or the body without the head and the breath sounds, you will place the stethoscope at extremities). Distal means farther away from the torso. For example, the midclavicular lines to listen to each side of ANATOMICAL chest and assess the function of both lungs. think of an elbow. It is proximal to the hand, because it is closer the to the PLANES torso than the hand. The elbow also is distal lo the shoulder, since the elbow is farther away from the torso than the shoulder. The terms arc usually used when describing locations on extremities. For example, to LIFELINE PREHOSPITAL EMERGENCY CARE be sure circulation has not been cut off after splinting an arm or leg. One must feel for a distal pulse. This is a pulse found in an extremity, a pulse point that is farther away from the torso than the splint. When

U Day 3

Organs in each Regions

Abdominal Quadrants and Regions

RIGHT HYPOCHONDRIAC 1. Ascending Colon 2. Gall bladder 3. Liver 4. Right Kidney 5. Small Intestine 6. Transverse Colon

UNIT 1 DAY 3

1. Esophagus 2. Liver 3. Pancreas 4. Right & Left Adrenal Gland 5. Right & Left Kidney 6. Small Intestine 7. Spleen 8. Stomach 9. Transverse Colon

LEFT HYPOCHONDRIAC 1. Descending Colon 2. Left Kidney 3. Liver 4. Pancreas 5. Small Intestine 6. Spleen 7. Stomach 8. Transverse Colon

RIGHT LUMBAR

1. Ascending Colon 2. Gall Bladder 3. Liver 4. Right Kidney 5. Small Intestine

LIFELINE

Organs in each Regions Organs in each Regions The abdomen is divided into four parts, or quadrants, by drawing horizontal and RIGHT HYPOCHONDRIAC vertical lines through the navel. The abdominal quadrants are described as the1.RIGHT right Ascending Colon HYPOCHONDRIAC 1. Ascending Gall bladder Colon upper quadrant, the left upper quadrant, the right lower quadrant, and the left2.lower 2. Gall bladder 3. Liver quadrant. These are often abbreviated as, respectively, RUO, LUO, RLQ, and LLQ. 3. Liver 4. Right Kidney 4. Right Kidney The abdomen is divided into four parts, or 5. Small Intestine 5. Small Intestine 6. Transverse Colon quadrants, by drawing horizontal and verti6. Transverse Colon EPIGASTRIC EPIGASTRIC cal lines through (he navel. The abdominal 1. Esophagus 1. Esophagus 2. Liver quadrants areQuadrant described as the right upper Left Upper Right Lower Quadrant 2. Liver 3. Pancreas quadrant, the left upper quadrant, the right 1. Liver 1. Colon 3. Pancreas 4. Right & Left Adrenal Glan 1. 2.Liver Liver 4. Right & Left Adrenal Gl Spleen 2.lower SmallquadIntestines lower quadrant, and the 1.left 5. Right & Left Kidney 5. Right & Left Kidney 2. 3.Colon 2. Spleen Left are Kidney 3. as, Major artery and veins of the right led6. Small Intestine rant. These often abbreviated respec6. Small Intestine 3. 4.Right Kidney 3. Left 7. Spleen Colon 4. Kidney Ureter 7. Spleen tively, RUO, LUO, RLQ, and4.LLQ. 8. Stomach Stomach 5. Appendix 4. 5.Pancreas Colon 8. Stomach 9. Transverse Colon 9. Transverse Colon 5. 6.GallPancreas Bladder 5. Stomach LEFT HYPOCHONDRIAC LEFT HYPOCHONDRIAC Left Lower Quadrant 6. Pancreas 1. Descending Colon 1. Descending Colon 1. Colon 2. Left Kidney 2. Left Kidney 2. Small Intestines 3. Liver 3. Liver 3. Major artery and veins of the left leg 4. Pancreas 4. Pancreas Right Upper Quadrants 1. Colon 1. Colon 4. Ureter 5. Small Intestine 5. Small Intestine Small Intestines 2. Small Intestines 1. 2. Liver 6. Spleen 6. Spleen Major artery and 3. Major artery and 7. Stomach 7. Stomach 2. 3. Colon 8. Transverse Colon 8. Transverse Colon veins of the right leg veins of the left leg 3. Right Kidney RIGHT LUMBAR RIGHT LUMBAR Ureter 4. Ureter 4. 4. Pancreas 1. Ascending Colon 1. Ascending Colon 5. Appendix 2. Gall Bladder 2. Gall Bladder 5. Gall Bladder 3. Liver 3. Liver 4. Right Kidney 4. Right Kidney ORGANS FOUND IN EACH QUADRANTS 5. Small Intestine 5. Small Intestine UMBILICAL UMBILICAL 1. Pancreas 1. Pancreas 2. Right & Left Kidneys 2. Right & Left Kidneys 3. Right & Left Ureters 3. Right & Left Ureters 4. Small Intestine 4. Small Intestine 5. Stomach 5. Stomach 6. Transverse Colon 6. Transverse LEFT LUMBARColon LEFT LUMBAR ² Limmer (Brady) 1. Descending Colon ³ Pollack, (AAOS) 1. Descending Colon 2. Left Kidney ⁴ NHTSA 2. Left Kidney 3. Small Intestine 3. SmallILIAC Intestine RIGHT RIGHT1.ILIAC Appendix 1. Appendix 2. Cecum 2. Cecum 3. Ascending Colon 3. Ascending Colon Tube 4. Right Fallopian 4. Right Fallopian 5. Right Ovary Tube 6. Small Intestine 5. Right Ovary HYPOGASTRIC 6. Small Intestine 1. Prostate HYPOGASTRIC 2. Rectum 1. Prostate 3. Right & Left Fallopian T 2. Rectum 4. Right & Left OvariesTub 3. Right & Left Fallopian 5. Right & Left Ureters 4. Right & Left Ovaries 6. Seminal 5. Right & LeftVessicle Ureters 7. Sigmoid Colon 6. Seminal Vessicle 8. Small Colon Intestine 7. Sigmoid 9. Urinary Bladder 8. Small Intestine 10.Uterus 9. Urinary Bladder 11.Vas Deferens 10.Uterus LEFT ILIAC 11.Vas Deferens 1. Left Fallopian Tube LEFT ILIAC 2. Left Ovary 1. Left Fallopian Tube 3. Small Intestine 2. Left Ovary 4. Descending Colon 3. Small Intestine 5. Sigmoid Colon 4. Descending Colon 5. Sigmoid Colon

Abdominal Quadrants and Regions

EPIGASTRIC

ANATOMY AND PHYSIOLOGY

PREHOSPITAL EMERGENCY CARE

FOUNDATION OF EMT PRACTICE

Organs in each Quadrants:

Right Upper Quadrants

QUADRANTS QUADRANTS

Left Upper Quadrant

Organs in each Quadrants: Right Lower Quadrant

Left Lower Quadrant

ORGANS FOUND IN EACH QUADRANTS

UNIT 1 UNIT31 DAY DAY 3

FOUNDATION OF EMT PRACTICE FOUNDATION OF EMT PRACTICE Organs in each region

REGIONS REGIONS REGIONS

UMBILICAL

1. Pancreas 2. Right and Left Kidneys 3. Right & Left Ureters 4. Small Intestine 5. Stomach 6. Transverse Colon

LEFT LUMBAR

1. Descending Colon 2. Left Kidney 3. Small Intestine

nd land

RIGHT ILIAC

1. Appendix 2. Cecum 3. Ascending Colon 4. Right Fallopian Tube 5. Right Ovary 6. Small Intestine

HYPOGASTRIC ORGANSORGANS FOUND IN EACH QUADRANTS FOUND EACH QUADRANTS ORGANS FOUND ININ EACH QUADRANTS

1. Prostate 2. Rectum 3. Right & Left Fallopian Tube 4. Right & Left Ovaries 5. Right & Left Ureters 6. Seminal Vessicle 7. Sigmoid Colon 8. Small Intestine 9. Urinary Bladder 10.Uterus 11.Vas Deferens

LEFT ILIAC

1. Left Fallopian Tube 2. Left Ovary 3. Small Intestine 4. Descending Colon 5. Sigmoid Colon

Tube be

LIFELINE

² Limmer (Brady) ³ Pollack, (AAOS)

PREHOSPITAL EMERGENCY CARE

There are five terms that describe specific patient positions: supine, prone, recovPositional Terms ery, Fowler and Trendelenburg. There are five terms that describe specific patient positions: supine, prone, recovANATOMY AND PHYSIOLOGY Day 3 ery, Fowler and Trendelenburg.

Positional Terms

There are five terms that describe specific patient positions: supine, prone, recovery, Fowler and Trendelenburg.

SUPINE POSITION

SUPINE POSITION SUPINE POSITION PRONE POSITION PRONE POSITION

PRONE POSITION PRONE POSITION PRONE POSITION

SIDE LYING POSITION

SIDE LYING POSITION SIDE LYING POSITION

RECOVERY POSITION RECOVERY POSITION 88

LIFELINE

PREHOSPITAL EMERGENCY CARE

RECOVERY POSITION

MUSCULOSKELETAL SYSTEM

LIFELINE

PREHOSPITAL EMERGENCY CARE

ANATOMY AND PHYSIOLOGY Day 3 The muscular system function 1. Gives the body shape. 2. Protects internal organs. 3. Provides for movement.

The muscular system function

1. Gives the body shape. 2. Protects internal organs. 3. Provides for movement.

Types of Muscle 1. Voluntary (skeletal)of Types

Muscle a. Attached to the bones.

a. Found in the walls of the tubular structures of the gastrointestinal tract and urinary system, as well as the blood vessels and bronchi. b. Control the flow through these structures. bones. c. Carry out the automatic muscular functions of the muscle mass ofbody. the body. d. individuals have no direct control of theovernervous system and brain. these muscles.

b. Form the major muscle mass of the body. c. Under control of the nervous 1. Voluntary system and brain. Can (skeletal) be contracteda. and relaxed by theto the Attached will of the individual. d. Responsible movement. b.forForm the major

LIFELINE

2. Involuntary (smooth)

e. Respond to stimuli such as stretching, heat, and cold.

3. Cardiac

a. Found only in the heart. b. Involuntary muscle - has its own supply of blood through the artery system. and Cancoronary be contracted

c. Under control relaxed by the will of the individual. PREHOSPITAL EMERGENCY CARE d. Responsible for movement. 2. Involuntary (smooth) a. Found in the walls of the tubular structures of the gastrointestinal tract

The Skeletal System Function 1. Gives the body shape 2. Protects vital internal organs 3. Provides for body movement

Skeletal System

The Skeletal System Function 1. Gives the body shape 2. Protects vital internal organs 3. Provides for body movement

LIFELINE

PREHOSPITAL EMERGENCY CARE

d. Mandible (jaw) e. Zygomatic bones (cheeks)

ANATOMY AND PHYSIOLOGY

Day 3

The Skull

Components

UNI DA

1. Skull - houses and protects the brain

UNIT 1 DAY 3

2. Face

a. Orbit b. Nasal bone c. Maxilla d. Mandible (jaw) e. Zygomatic bones (cheeks)

FOUNDATION OF EMT PRACTICE 3. Spinal Column a . Cervical (neck) - 7 b. Thoracic (upper back) - 12 c. Lumbar (lower back) - 5 d. Sacral (back wall of the pelvis) - 5 e. Coccyx (tailbone) - 4

The Skull (side view)

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

3. Spinal Column

a .Cervical (neck) - 7 b. Thoracic (upper back) - 12 c. Lumbar (lower back) - 5 d. Sacral (back wall of the pelvis) ²-Limmer 5 (Brady) ³ Pollack, (AAOS) e. Coccyx (tailbone) - 4 ⁴ NHTSA

Divisions of Spine

LIFELINE

PREHOSPITAL EMERGENCY CARE

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

i. Manubrium (superior portion of sternum) ii. Body (middle) iii. Xiphoid process (inferior portion of sternum)

IT 1 AY 3

FOUNDATION OF EMT PRACTICE 5. Pelvis a. Iliac crest (wings of pelvis) a. Ribsportion of pelvis) b. Pubis (anterior i. 12portion pair of pelvis) c. Ischium (inferior

4. Thorax

ii. Attached posterior to the 6. Lower extremities Thoracic vertebrae. iii. Pairs 1-10 are attached anterior a. Greater trochanter (ball) and acetabulum (socket of hip bone) [Make up to the sternum. the hip joint] iv. Pairs 11 and 12 are floating. b. Femur (thigh) b. Sternum (Breastbone) c. Patella (kneecap) i. Manubrium (superior portion of d. Tibia (shin - lower leg) sternum) e. Fibula (lowerii. leg) Body (middle) iii. Xiphoid process (inferior f. Medial and lateral malleolus - surface landmarks of the ankle joint. portion (foot) of sternum) g. Tarsals and metatarsals h. Calcaneus (heel) Phalanges (toes)

5. Pelvis ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

a. Iliac crest (wings of pelvis) b. Pubis (anterior portion of pelvis) c. Ischium (inferior portion of pelvis)

6. Lower extremities

a. Greater trochanter (ball) and acetabulum (socket of hip bone) [Make up the hip joint] b. Femur (thigh) c. Patella (kneecap) d. Tibia (shin - lower leg) e. Fibula (lower leg) f. Medial and lateral malleolus - surface marks of the ankle joint. g. Tarsals and metatarsals (foot) h. Calcaneus (heel) Phalanges (toes)

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

LIFELINE

PREHOSPITAL EMERGENCY CARE

f.(lateral Radius (lateral of forearm) f. Radius (lateral bone of forearm) f. Radius bone of bone forearm) g. Ulna (medial of forearm) g. Ulna (medial of forearm) g. Ulnabone (medial bone of bone forearm) h. Carpals (wrist) h. Carpalsh.(wrist) Carpals (wrist) i. Metacarpals (hand) Phalanges (fingers) i. Metacarpals (hand) Phalanges (fingers) i. Metacarpals (hand) Phalanges (fingers) ANATOMY AND PHYSIOLOGY Day 3

7. Upper extremities

a. Clavicle (collar bone) b. Scapula (shoulder blade) c. Acromion (tip of shoulder) d. Humerus (superior portion of upper extremity) e. Olecranon (elbow) f. Radius (lateral bone of forearm) g. Ulna (medial bone of forearm) h. Carpals (wrist) i. Metacarpals (hand) Phalanges (fingers)

² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) LIFELINE³ Pollack, PREHOSPITAL (AAOS) EMERGENCY CARE ⁴ NHTSA ⁴ NHTSA

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

RESPIRATORY SYSTEM Components

RESPIRATORY SYSTEM

1. Nose and mouth 2. Pharynx a. Oropharynx. b. Nasopharynx 3. Epiglottis and liquid entering Nose and mouth - a leaf-shaped structure that prevents 5. Cricoidfood cartilage - firmfrom cartilage ringthe trachea during swallowing forming the lower portion of the larynx. Pharynx4. Trachea (windpipe) 5. Cricoid cartilage - firm cartilage ring forming the lower portion a. Oropharynx. 6. Larynx (voice box)of the larynx. b. Nasopharynx 6. Larynx (voice box) 7. Bronchi two major branches of 7. Bronchi - two major branches of the trachea to the -lungs. Bronchus subdivides into Epiglottis smaller - a leaf-shaped structure that air passages ending at the alveoli. the trachea to the lungs. Bronchus prevents food and liquid from entering subdivides into smaller air passages 8. Lungs the trachea during swallowing ending at the alveoli. 9. Diaphragm

Components 1. 2. 3.

4. Trachea (windpipe)

8. Lungs 9. Diaphragm

LIFELINE ² Limmer (Brady)

³ Pollack, (AAOS) ⁴ NHTSA

PREHOSPITAL EMERGENCY CARE

UNIT 1 DAY 3 UNIT 1 DAY 3

FOUNDATION OF EMT PRACTICE FOUNDATION EMT PRACTICE ANATOMY OF AND PHYSIOLOGY

Day 3

UPPER AIRWAY

Respiratory Physiology Inhalation is an active process. The muscles of the rib

cage (intercostal muscles) and the diaphragm contract The diaphragm lowers, and the ribs move upward and outward. This expands the size of the chest and thereby creates a negative pressure inside the chest cavity. This negative pressure pulls air into the lungs.

Exhalation is a passive process during which the

intercostal muscles and the diaphragm relax. The ribs move downward and inward, while the diaphragm rises. This movement causes the chest to UNIT 1 decrease in size and positive pressure to build inside the chest3 DAY cavity. This positive pressure pushes air out of the lungs. During inhalation, air is moved through the airway and into the alveoli. These tiny sacs in the lungs are the site of gas exchange between air and blood. Each single alveolus is surrounded by pulmonary capillaries. The pulmonary capillaries bring circulating blood to the outside of the alveoli. Through the very thin walls of the alveoli and the capillaries, oxygen is transferred from the air inside the alveoli to the bloodstream and carbon dioxide is moved from the bloodstream into the air within the alveoli. This movement of gases to and from the Alveoli is called ventilation 96

LIFELINE

Respiratory Physiology Inhalation is an active process. The muscles of the rib cage (intercostal muscles) and the diaphragm contract The diaphragm lowers, and the ribs move upward and outward. This expands the size of the chest and thereby creates a negative Respiratory Physiology pressure inside the chest cavity. This negative pressure pulls air into the lungs.

Air entering lungs

Inhalation is an active process. The muscles of the rib cage (intercostal muscles) and the diaphragm contract The diaphragm lowers, and the ribs move upward and outward. This expands the size of the chest and thereby creates a negative pressure inside the chest cavity. This negative pressure pulls air into the lungs.

FOUNDATION OF EMT PRACTICE Exhalation is a passive process during which the intercostal muscles and the diaphragm relax. The ribs move downward and inward, while the diaphragm rises. This movement causes the chest lo decrease in size and positive pressure to build inside the chest cavity. This positive pressure pushes air out of the ² Limmer (Brady) lungs. ³ Pollack, (AAOS) ⁴ NHTSA

Air expelled from lungs

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

During inhalation, air is moved through the airway and into the alveoli. These tiny sacs in the lungs are the site of gas exchange between air and blood. Each single alveolus is surrounded by pulmonary capillaries. The pulmonary capillaries PREHOSPITAL EMERGENCY CARE bring circulating blood to the outside of the alveoli. Through the very thin walls of the alveoli and the capillaries, oxygen is transferred from the air inside the alveoli to the bloodstream and carbon dioxide is moved from the bloodstream into the air within the alveoli. This movement of gases to and from the Alveoli is called ventilation Oxygenated blood is carried from the lungs to the heart so il can be pumped

Oxygenated blood is carried from the lungs to the heart so it can be pumped into the body’s circulatory system. As the blood leaves the heart. it travels through a branching series of arteries that gradually become smaller and finally connect to capillaries. Just as happened with the capillaries that pass by the alveoli of the lungs the capillaries that pass by the cells throughout the body’s tissues conduct a gas exchange. At a cellular level, oxygen that was picked up from the lungs and carried by the blood is now transferred through the capillary walls and across cell membranes into the cells. Waste carbon dioxide from the cells moves in the opposite direction, out of the cells and into the capillaries. Capillaries then connect to veins and veins return blood to the heart where it can be pumped to the lungs to get rid of the waste carbon dioxide and pick up oxygen, completing the cycle of gas exchange. The process of moving gases (and other nutrients) between the cells and the blood is called respiration, The exchange of gases, both in the lungs and at the body’s cells, is critical to support life, Oxygen is essential to sustain normal cellular function, and the removal of carbon dioxide helps regulate the body’s pH. or relative acidity. In general, the body regulates its pH through the buffer system, and the removal of carbon dioxide is an extremely important element of this system.

b. Capillaries give up oxygen to the cells. 3. Adequate breathing a. Normal rate i. Adult - 12-20/minute ii. Child - 15-30/minute iii. Infant - 25-50/minute b. Rhythm i. Regular ii. Irregular 1. Alveolar/capillary exchange 3. Adequate breathing c. Quality a. Oxygen-rich air enters the alveoli during each inspia. Normal rate i. Breath sounds - present and equal ration. i. Adult - 12-20/minute b. Oxygen-poor blood in the capillaries passes-into the ii. Child - 15-30/minute ii. Chest expansion adequate and equal alveoli. iii. Infant - 25-50/minute iii. capillaries Effort of breathing muscles - predomic. Oxygen enters the as carbon dioxide - use ofb.accessory Rhythm enters the alveoli. nantly in infants and children i. Regular ii. Irregular d. Depth (tidal volume) – adequate c. Quality 4. i. Breath sounds - present and equal 2. Inadequate Capillary/cellular breathing exchange

Respiratory physiology

a. Cells give up carbon dioxide to the capillaries. b. Capillaries give up oxygen to the cells.

ii. Chest expansion - adequate and equal iii. Effort of breathing - use of accessory muscles - predominantly in infants and children d. Depth (tidal volume) – adequate

4. Inadequate breathing

a. Rate - outside of normal ranges. b. Rhythm – irregular c. Quality i. Breath sounds - diminished or absent ii. Chest expansion - unequal or inadequate iii. Increased effort of breathing - use of accessory muscles - predominantly in infants and children d. Depth (tidal volume) - inadequate/shallow e. The skin may be pale or cyanotic (blue) and cool and clammy. f. There may be retractions above the clavicles, between the ribs and below the rib cage, especially in children. g. Nasal flaring may be present, especially in children. h. In infants, there may be “seesaw” breathing where the abd men and chest move in opposite directions i. Agonal respirations (occasional gasping breaths) may be seen just before death.

INADEQUATE BREATHIING

HIRAP SA PAGHINGA Malalaman mo na hirap sa paghinga ang iyong pasyente kung nanlalamig ang balat nito, nakatukod ang katawan at pinipilit na huminga -- mababaw ang pag-inhale at mabilis na pagexhale. Ang ibig sabihin nito ay kinakapos sa hangin ang pasyente.

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e. Diaphragm - chest wall is softer, infants and children tend to

i. Breath sounds - diminished or absent depend more heavily on the diaphragm for breathing. ii. Chest expansion - unequal or inadequate iii. Increased effort of breathing - use of accessory muscles predominantly in infants and children d. Depth (tidal volume) - inadequate/shallow e. The skin may be pale or cyanotic (blue) and cool and clammy. f. There may be retractions above the clavicles, Day 3between the ribs and below the rib cage, especially in children. g. Nasal flaring may be present, especially in children. h. In infants, there may be "seesaw" breathing where the abdomen and chest move in opposite directions i. Agonal respirations (occasional gasping breaths) may be seen just before death. 5. Infant and child anatomy considerations a. Mouth and nose - in general: All structures are smaller and more easily obstructed than in adults. CIRCULATORY (CARDIOVASCULAR) SYSTEM b. Pharynx - infants' and children's tongues take up proportionally more space in the mouth than adults. c. Trachea (windpipe) i. Infants and children have narrower tracheas that are obstructed more easily by swelling. ii. The trachea is softer and more flexible in infants and children. d. Cricoid cartilage - like other cartilage in the infant and child, the andis less developed and less rigid. cricoid Infants cartilage Young Children e. Diaphragm - chest wall is softer, infants and children tend to rely on the depend more heavily on the diaphragm for breathing.

ANATOMY AND PHYSIOLOGY

UNIT 1 DAY 3

FOUNDATION OF EMT PRACTICE

CIRCULATORY (CARDIOVASCULAR) SYSTEM

Diaphragm to breath more than the adults do.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

5. Infant and child anatomy considerations

a. Mouth and nose - in general: All structures are smaller and more easily obstructed than in adults. b. Pharynx - infants’ and children’s tongues take up proportionally more space in the mouth ² Limmer than (Brady) ³ Pollack, (AAOS) adults. ⁴ NHTSA c. Trachea (windpipe) i. Infants and children have narrower tracheas that are obstructed more easily by swelling. ii. The trachea is softer and more flexible in infants and chi dren. d. Cricoid cartilage - like other cartilage in the infant and child, the cricoid cartilage is less developed and less rigid. e. Diaphragm - chest wall is softer, infants and children tend to depend more heavily on the diaphragm for breathing.

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UN D

NIT 1 DAY 3

a. Atrium i. Right - receives blood from the veins of the body and the heart, pumps oxygen-poor blood to the right ventricle. ii. Left receives blood from the pulmonary veins (lungs), pumps Cardiac- conductive system oxygen-rich blood to left ventricle. b. Ventricle a. Heart is more than a muscle. i. Rightb.- Specialized pumps blood to the lungs. contractile and conductive tissue in the heart ii. Left -c.pumps blood to the body. Electrical impulses iii. Valves prevent backflow of blood.

HEART

CROSS SECTION OF THE HEART

Structure/function a. Atrium

i. Right - receives blood from the veins of the body and the heart, pumps oxygen-poor blood to the right ventricle. ii. Left - receives blood from the pulmonary veins (lungs), pumps oxygen-rich blood to left ventricle.

b. Ventricle

i. Right - pumps blood to the lungs. ii. Left - pumps blood to the body. iii. Valves prevent backflow of blood.

FOUNDATION OF EMT PRACTICE Arteries

ARTERIES

Cardiac conductive system a. Heart is moresystem than a muscle. Cardiac conductive b. Specialized contractile and conductive tisinisthe heart a.sue Heart more than a muscle. c. b.Electrical Specialized impulses contractile and conductive tissue in the heart c. Electrical impulses

CONDUCTION SYSTEM

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

Arteries a. Function - carry blood away from the heart to the rest of the body. b. Major arteries i. Coronary arteries - vessels that sup-

a. Function - carry blood away from the heart to the rest of the body. b. Major arteries - carry blood away from the heart- vessels to the that rest supof i. Coronary arteries the ply thebody. heart with blood. ii. Aorta 1) Major artery originating from heart, lying in front of the i.the Coronary arteries - vessels spine in the thoracic and abthat supply the heart with dominal cavities. blood. 2) Divides at the level of the navel the iliac arteries. ii.into Aorta

a. Function

b. Major arteries

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

1) Major artery originating from the heart, lying in front of the spine in the thoracic and abdominal cavities. 2) Divides at the level of the navel into the iliac arteries. 3 ) Pulmonary • Artery originating at the right ventricle. • Carries oxygen-poor blood to the lungs. 4) Carotid • Major artery of the neck. • Supplies the head with blood. • Pulsations can be palpated on either side of the neck. 5) Femoral • The major artery of the thigh. • Supplies the lower extremities with blood. • Pulsations can be palpated in the groin area (the crease between the abdomen and thigh). LIFELINE

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  

UNIT 1 DAY 3

Major artery of the neck. Supplies the head with blood.

FOUNDATION OF EMT PRACT

Pulsations can be palpated on either side of the neck. 5) Femoral

Day 3

 The major artery of the thigh. ANATOMY AND PHYSIOLOGY  Supplies the lower extremities with blood. 

Pulsations can be palpated in the groin area (the crease between the6) abdomen Radialand thigh). 6) Radial

• Major artery of the lower arm. can be palpated at the wrist thumb side. Pulsations can 7) be Brachial palpated at the wrist thumb side. ) Pulmonary •3An artery of the upper arm. 7) Brachial • Pulsations can be palpated on the inside of the  between Arterytheoriginating at the right ventricle.  An artery of the upper armarm. elbow and the shoulder.  Pulsations can be palpated on the inside of the • UsedCarries when determining a blood blood pressureto (BP) oxygen-poor the lungs. arm between the elbow and the shoulder. using a BP cuff (sphygmomanometer) and a stethoscope.  Used when determining a blood pressure (BP) 4) Carotid 8) Posterior tibial - pulsations can be palpated on the using a BP cuff (sphygmomanometer) and a stethoposterior surface of the medial  Major artery of themalleolus. neck. scope. “ 9) Dorsalis pedis 8) Posterior tibial - pulsations can be palpated on the • An artery in the foot  malleolus. Supplies the head with blood. posterior surface of the medial • Pulsations can be palpated on the anterior surface of 9) Dorsalis pedis  foot. Pulsations can be palpated on either side the  An artery in the foot  



Major artery of the lower arm. • Pulsations

neck. Arteriole branch of an artery 5) Femoral leading to the capillaries.

Pulsations can be palpated on the anterior surface of - the smallest the foot.

Arteriole - the smallest branch of an artery leading to the capillaries.

a. Tiny blood vessels that connect arterioles to venules b. Found in all parts of the body c. Allow for the exchange of nutrients and waste at the cellular level

UNIT 1 DAY 3

CRITICAL CONCEPT Red blood cells give the blood its color. It also carries oxygen to organs. And carry carbon dioxide away from organs. While White blood cells - part of the body's defense against infections. Plasma - fluid that carries the blood cells and nutrients. And Platelets - essential for the formation of blood clots.

The major artery of the thigh.

 

connect arterioles Major artery of the lower arm. to

Supplies the lower extremities with blood.

CAPILLARIES

Pulsations can be palpated in the groin are crease between the abdomen and thigh). 6) Radial

Capillaries

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

  

a. Tiny blood vessels that venules

Pulsations canb. be palpated the wrist th Found in all partsat of the body side. c. Allow for the exchange 7) Brachial of nutrients and waste at cellular level  An artery of the the upper arm.

CAPILLARY  FOUNDATION Pulsations can be on the inside o OFpalpated EMT PRACTICE arm between the elbow and the shoulder.

 Used when determining a blood pressure VEINS using a BP cuff (sphygmomanometer) and a s

Veins

scope.

a. Function - vessels that carry 8) Posterior tibial pulsations can be a. Function - vessels blood- back VEINpalpated o blood back tothat thecarry heart. to the heart. b. Major veins i. Pulmonary vein - carries oxygen-rich i.blood Pulmonary - carries from thevein lungs to the left oxygen-rich blood from the atrium. lungscavae to the left atrium. ii. Venae Superior ii.1)Venae cavae 2) 1)Inferior Superior 3) oxygen-poor blood back 2) Carries Inferior to the right atrium. 3) Carries oxygen-poor blood

posterior surface of the medial malleolus.

b. Major veins 9) Dorsalis pedis  An artery in the foot  Pulsations can be palpated on the anterior surfa the foot.

Arteriole - the smallest branch ofbranch an artery leading to the capillaries. Venuleback - thetosmallest of a vein the right atrium. leading to the capillaries.

Venule - the smallest branch of a vein leading to the capillaries.

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Capillaries

Blood

a. Tiny blood vessels that connect arterioles

Venule

- the smallest branch of a vein

leading to the capillaries.

TICE Blood BLOOD

White blood cells - part of

the body’s defense against infections.

Plasma - fluid that carries the blood cells and nutrients.

Platelets - essential for the

formation of blood clots.

Ang Red Blood Cells ang nagbibigay sa dugo ng kulay pula. Nagdadala itong oxygen sa mga internal organs ng katawan at nagdadala naman ng carbon dioxide palayo sa mga organs.

ea (the

Ang White Blood Cells naman ang siyang nagsisilbing sundalo na panlaban ng katawan sa mga impeksyon.

humb

of the

on the

ace of

Red blood cells - give the blood

its color. It also carries oxygen to organs. And carry carbon dioxide away from organs.

of the

e (BP) stetho-

CRITICAL CONCEPTS

Physiology ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

1. Central Pulses a. Carotid b. Femoral

2. Blood Pressure

a. Systolic - the pressure exerted against the walls of the artery when the left ventricle contracts.

3. Perfusion - circulation of blood

through an organ or a structure. a. Perfusion is the delivery of oxygen and other nutrients to the cells of all organ systems and the removal of waste products.

b. Hypoperfusion is the inadequate circulation of blood through an organ or a structure.

4. Inadequate circulation - Shock

Ang Plasma ay ang likido ng dugo kung saan naroon ang Red Blood Cells at White Blood Cells pati na rin ang mga sustansya na kailangan ng iba’t ibang bahagi ng katawan. Ang Platelets naman ay mahalaga para sa pagkabuo o clotting ng dugo.

(hypoperfusion): A state of profound depression of the vital processes of the body, characterized by signs and symptoms such as: Pale, cyanotic (blue-gray color), cool, clammy skin, rapid, weak pulse, rapid and shallow breathing, restlessness, anxiety or mental dullness, nausea and vomiting, reduction in total blood volume, low or decreasing blood pressure and subnormal temperature.

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FOUNDATION OF EMT PRACTICE

DAY 3

1. Function - controls the voluntary and involuntary activity of the body 2. 3Components ANATOMY AND PHYSIOLOGY Day a. Central nervous system i. Brain - located within the cranium.

NERVOUS SYSTEM

NIT 1 AY 3

FOUNDATION OFinvoluntary EMT PRACTICE 1. Function - controls the voluntary and activity of the body.

2.2. Components Components

UNIT 1 DAY 3

FOUNDATION OF EMT PRACTICE

a. Central nervous system a. Central nervous system

i. Brain - located within the cranium. 2. Components

i. Brain - located within the cranium.

a. Central nervous system i. Brain - located within the cranium.

ii. Spinal cord - located within the spinal column from the brain through the lumbar vertebrae.

ii. Spinal cord - located within the spinal column from the

brain ii. Spinal cord - through the lumbar vertebrae.² Limmer (Brady) ³ Pollack, (AAOS) located within ⁴ NHTSA the spinal column from the brain through the lumbar vertebrae.

b. Peripheral nervous system i. Sensory - carry information from the body to the brain and spinal cord. ii. Motor - carry information from the brain and spinal cord to the body.

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b. Peripheral nervous system i. Sensory - carry information from the body to the brain and spinal cord. ii. Motor - carry information from the brain and spinal cord to the body.

INTEGUMENTARY SYSTEM â&#x20AC;&#x201C; SKIN 1. Function

2. Layers

INTEGUMENTARY SYSTEM â&#x20AC;&#x201C; SKIN a. Protects the body from the environment, bacteria and other organisms. b. Helps regulate the temperature of the body. c. Senses heat, cold, touch, pressure and pain; transmits this information to the brain and spinal cord.

a. Epidermis - outermost layer of skin. b. Dermis - deeper layer of skin containing sweat and sebaceous glands, hair follicles, blood vessels and nerve endings. c. Subcutaneous layer

1. Function a. Protects the body from the environment, bacteria and other organisms. LIFELINE PREHOSPITAL EMERGENCY CARE b. Helps regulate the temperature of the body. c. Senses heat, cold, touch, pressure and pain; transmits this information to the brain and spinal cord.

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DIGESTIVE SYSTEM

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FOUNDATION OF EMT PRACTICE ANATOMY AND PHYSIOLOGY

DIGESTIVE SYSTEM

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ENDOCRINE SYSTEM

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UNIT 1 DAY 3

FOUNDATION OF EMT PRACTICE Unit 1

Day 3

ANATOMY AND PHYSIOLOGY

REPRODUCTIVE SYSTEM REPRODUCTIVE SYSTEM

MALE REPRODUCTIVE SYSTEM

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UNIT 1 DAY 3

FOUNDATION OF EMT PRACTICE

FEMALEREPRODUCTIVE REPRODUCTIVESYSTEM SYSTEM(EXTERNAL) (EXTERNAL) FEMALE

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UNIT 1 DAY 3 Day 3

FOUNDATION OF EMT PRACTICE ANATOMY AND PHYSIOLOGY

REPRODUCTIVE SYSTEM (INTERNAL) FEMALEFEMALE REPRODUCTIVE SYSTEM (INTERNAL)

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UNIT 1 DAY 3

UNIT 1 DAY 3 UNIT 1 DAY 3

1 3

FOUNDATION OF EMT PRACTICE

FOUNDATION OF EMT PRACTICE KIDNEY KIDNEY

EXCRETORY SYSTEM

KIDNEY

URINARY BLADDER URINARY BLADDER

URINARY BLADDER ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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PATHOPHYSIOLOGY is a big word. The dictionary defines it as the study of the abnormal physiological processes that cause or are associated with disease or injury. Pathophysiology is an important part of your training as an EMT. It is a complement to the preceding chapted on anatomy and physiology. If anatomy and physiology showed you the processes of the body and its systems in a healthy state, pathophysiology, by contrast, would show you how the body and its systems work when a disease or an injury occurs. As a future EMT, you must understand the disease and

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injury process â&#x20AC;&#x201D; and how to treat your would-be patients. This chapter will equip you with the basic fundamentals of pathophysiology that would come handy later on in your career. When you become an EMT, you will be required to work as part of a team. You will be working with physicians, nurses, pharmacists, and nutritionists -- all of whom are wellversed in pathophysiology. Through this chapter, you will be able to understand the complexities of diseases and eventually find it easy to work with medical experts later on when you become a full-pledged EMT.

DAY

The Fundamentals Of Pathophysiology Types of Cell Diseases of the Heart and Lungs Pathophysiology of Other Systems

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Day 4

CRITICAL CONCEPTS The human body is an amazing system. Its capacity to adapt to and overcome challenges seems limitless. As an EMT, it will be very useful for you to understand how common illnesses and injuries affect the body and, more importantly, how the body reacts to and compensate for CRITICAL these challenges.CONCEPT Pathophysiology is the study of how disease processes affect the functions of the body. The body is an amazing system Its capacity to adapt to and overcome challenges seems limitless. As an EMT, it is very useful to understand how common illnesses and injury affect the body and. more important how the body will react to and compensate for these insults. Pathophysiology is the study of how disease processes affect the function of the body. Ang pag-aaral tungkol sa pathophysiology ay makakatulong sa Understanding pathophysiology will iyo upang malaman help you recognize the changes your ang mga pagbabagong patient is going through as a result of pinagdadaanan ng help you illness or injury. It will also pasyente sanhicounteract understandiyong how to best ng pagkakasakit those changes to improve the outcome o pagkadisgrasya. of your patient. Makakatulong din ito sa iyo para malaman kung ano ang dapat gawin para makontra ang mga pagbabagong iyon para bumuti ang lagay ng iyong pasyente.

FOUNDATION OF EMT PRACTICE

FOUNDATION OF EMT FUNDAMENTALS OF PRACTICE PATHOPHYSIOLOGY

UNIT 1 DAY 4

PRINCIPLES OF PATHOPHYSIOLOGY LEARNING OBJECTIVES LEARNING OBJECTIVES • Discuss the basics of anatomy, 

  

• Discuss the basic anatomy, physiology, epidemiology, physiology, epidemiology, pathophysiology, psychosocial pathophysiology, psychosocial Discuss thepresentations, fundamental anatomy, physiology, presentations, and epidemiology, impact, and core of the impact, of diabetic emergencies; prognosis of the psychosocial emergent pathophysiology, impact, prognosis presentations, and prognosis of the • Distinguish the symptoms diseasedisease conditions of the cerebral emergent conditions of the cerebral circulation, Seizureand disorders, and treatment plans of the irritable circulation, seizure disorders, and headache; bowel syndrome, inflammatory headaches. Discuss the the underlying epidemiology, pathophysiology, disorders, pancreatitis, bowel • Discuss underlyinganatomy, anatomy, physiology, psychosocial presentations, and obstruction, prognosishernias, of Acute and chronic gasinfectious physiology,impact, epidemiology, and gall bladder and pathophysiology, psychosocial trointestinal hemorrhage, Liver disorders,disorders, Peritonitis, Ulcerative diseases. biliary tract disorders. impact, presentations, and Discuss the basic core of anatomy, physiology, epidemiology, pathophysiolprognosis of acute and chronic ogy, psychosocial impact, presentations, and prognosis of diabetic emergengastrointestinal hemorrhage, cies; liver disorders, peritonitis, and ulcerativethe diseases. Distinguish symptoms and treatment plans of the irritable; bowel syn-

drome, Inflammatory disorders, Pancreatitis, Bowel obstruction, Hernias, Infectious disorders, Gall bladder and biliary tract disorders;

INTRODUCTION

STRUCTURE OF THE CELL

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A normal cell incorporates a series of structures that arc designed to accomplish functions. Common cell structures include the nucleus, the endoplasmic reticulum. And mitochondria. The cell nucleus, for example contains DNA. the genetic blueprint for duct ion. The structures within a cell are covered by a cell mem-

FOUNDATION OF EMT PRACTICE FOUNDATION OF EMT PRACTICE TYPES OF CELLS TYPES OF CELLS TYPES CELLS TYPES OF OF CELLS

DAY 4 UNIT 1 DAY 4

THE CELL A normal cell incorporates a series of structures that are designed to accomplish various functions. Common cell structures include the nucleus, the endoplasmic reticulum, and mitochondria. The cell nucleus contains DNA, the body’s genetic blueprint. The structures within a cell are covered by a cell membrane that protects it while allowing water and other substances into and out of the cell. Although some types of cells, like cardiac muscle cells, are specialized to serve specific purposes, some important components and functions are common to most cells. The endoplasmic reticulum, for example, plays a key role in synthesizing proteins.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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113

2. much water cell systems don’t work properly 4. too Oxygen and the –Cell 3. Water and Electrolytes cell functions using oxygen Aerobic Metabolismin– the cellular 4. Oxygen and the Cell Anaerobic Metabolism – cellular functions not using oxygen Aerobic Metabolism – cellular functions using oxygen Anaerobic Metabolism – cellular functions not using oxygen

Day 4

FUNDAMENTALS OF PATHOPHYSIOLOGY

WATER AND THE CELL

AEROBIC METABOLISM

A cell needs the correct balance of water between its inside and outside. Without enough water cell will dehydrate and die. In contrast, with too much water, basic cellular function be interrupted. Water also influences the concentrations of important chemicals called electrolytes. Electrolytes are substances that when dissolved in water, separate into charged particles. The movement of these charged particles enables the electrical functions of cells such as nerve transmission and cardiac muscle depolarization. Levels of water in the body are controlled by the circulatory and renal systems

CONCEPT :

ANAEROBIC METABOLISM

1. Too little water – cell dehydrated and dies 2. Too much water – cell systems don’t work pro perly 3. Water and Electrolytes in the cell 4. Oxygen and the Cell Aerobic Metabolism – cellular functions using oxygen Anaerobic Metabolism – cellular functions not using oxygen

GLUCOSE AND THE CELL Glucose a simple sugar converted from the foods we eat. is the basic nutrient of the cell. It is also the building block for energy in the form of ATP Without glucose, energy is not created and cell function ceases.

OXYGEN AND THE CELL ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

Healthy metabolism requires oxygen. Oxygen is used by the cell to metabolize glucose into end of the waste products of this metabolism is carbon dioxide. When oxygen enters the cell in the correct quantity, energy is produced in an efficient manner with minimal waste products. When this process (metabolism) takes place in the presence of oxygen, it is called aerobic metabolism. When glucose is metabolized without oxygen, or without enough oxygen, energy produced inefficiently and with a great deal more waste. In addition lo carbon dioxide, lactic acid is produced. When this process (metabolism) lakes place without oxygen, it is called anaerobic metabolism, a form of energy conversion that is not healthy for the body. The waste products of anaerobic metabolism make the body more acidic than normal, and this acidity impacts many systems negatively. Oxygenation of

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the cells and the removal of the waste products of metabolism are among the responsibilities of the respiratory system. The cell membrane is also a vulnerable clement of the cell. Many disease processes alter its permeability, or its ability to effectively transfer fluids, electrolytes, and other substances in and out. An ineffective cell membrane can allow substances into the cell that should not be there (like toxins) and interfere with the regulation of water. Thus far we have been discussing the structure and function of one cell. Remember. however, that many cells working together to form organ systems, and just as a single cell’s function can be disturbed by illness or injury, so can the function of an entire organ system.

CARDIOVASCULAR SYSTEM

AIRWAY

There is an old saying that air goes in, air goes out, and blood goes round and round. We often say this in EMS when referring to the proper function of the lungs and heart. It is an attempt to simplify a complicated process, and it sums up the importance of some of the bodyâ&#x20AC;&#x2122;s most basic functions.

The respiratory system begins at the airway. The airway is made up of the structures from the mouth and nose to the alveoli of the lungs. Air follows a path from the openings of the mouth and nose into the pharynx and/or nasopharynx, travels to the rear of the throat (or hypopharynx), then enters the larynx, below which the trachea begins. Air travels down the trachea to the point where it branches into two large tubes called the mainstem bronchi. One leading to each lung. Air follows the paths of the bronchi as they subdivide and subdivide again (like branches of a tree) until they reach their endpoints at the multitude of tiny air pockets in the lungs called alveoli. The alveoli are where the exchange of oxygen and carbon dioxide with the blood takes place.

Cells need oxygen for the efficient production of energy. As humans, we obtain oxygen from the air we breathe. Typically, the air we inhale contains mostly nitrogen (79%) and oxygen (21%). The concentration of oxygen in the air we breathe in is referred to as the fraction of inspired oxygen, or Fi02. We use our lungs to bring that oxygen into our bodies and our blood to distribute it to the cells. Our blood also picks up waste carbon dioxide from the cells and transports it back to the lungs, where it can be breathed out. The term cardiopulmonary system refers lo the combination of the respiratory and cardiovascular systems. The lungs, heart, blood vessels, and the blood itself work in concert to perform cardiopulmonary functions. The primary function of the cardiopulmonary system is to deliver oxygen and nutrients to the cells and to remove waste products from the cells. These basic operations rely on the coordinated movements of blood and air. Interruption of any part of this balance results in a compromise to or even a failure of the system.

Each bronchiole terminates in a tiny air pocket called an alveolar sac. The alveoli are encased by networks of capillaries; oxygen and carbon dioxide are exchanged between the air in the alveoli and the blood in the capillaries. Moving air in and out of the chest requires an open pathway. In EMS we refer to this open pathway as a patent airway. Although a healthy person with a normal mental status should have no problem keeping his airway open, there arc a number of potential airway challenges that occur with disease and trauma. Upper airway (above the trachea) obstructions arc common. These obstructions can be caused by foreign bodies (as in a person choking), by infection (such as a child with croup) or even by trauma or burns causing the soft tissue of the larynx to swell. Any of these obstructions can seriously and significantly inhibit the flow of air and interrupt the process of moving oxygen in and carbon dioxide out.

Common Respiratory Problems The common diseases of the respiratory system are the following: 1) Common cold 2) Chronic obstructive pulmonary disease (COPD) 3) Asthma 4) Tuberculosis 5) Bronchitis

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Day 4

FUNDAMENTALS OF PATHOPHYSIOLOGY

CRITICAL CONCEPTS ACCESSORY MUSCLES OF EXHALATION The following accessory muscles of exhalation are used to decrease the size of the thoracic cavity and to create a more positive pressure, forcing air out of the lungs. � Abdominal muscles contract and increase the pressure inside the abdominal cavity, forcing the diaphragm to move higher against the lungs. � Internal intercostals muscles contract and pull the sternum and ribs downward.

ACCESSORY MUSCLES OF INHALATION The following accessory muscles of inhalation are used to increase the size of the thoracic cavity and generate a greater negative pressure, increasing the flow of air into the lungs. � Sternocleidomastoid muscles lift the sternum upward. � Scalene muscle elevate ribs 1 and 2. � Pectoralis minor muscles elevate ribs 3 to 5.

THINGS TO CONSIDER IN RESPIRATORY CASES 1. Tidal Volume – volume of air moving in and out during each breath cycle 2. Tidal Volume X RR = Minute volume 3. Disruption of Respiratory Control a. Respirations controlled in brain by the medulla oblongata b. Event impacting function of the medulla oblongata can affect the minute volume 4. Disruption of Pressure 5. Disruption of Lung Tissue

DISEASES OF THE PLEURA AND CHEST 1. RESPIRATORY COMPROMISE ASSOCIATED WITH MECHANICS OF VENTILATION a. An increase in airway resistanve or decrease in lung compliane can interfere with ventilation. b. Compliance – a measure of the ability of the chest wall and lungs to stretch, distend and expand. c. Airway resistance – the ease of air flow down the conduit of airway structures leading to the alveoli. d. Pleural Space e. Minute Ventilation – respiratory rate multiplied by the volume of air moved in and out of the llungs with each breath i. average adult – tidal volume is 500ml ; frequency is 12bpm MV = 500ml X 12bpm = 6000ml/min or 6L/min f. Alveolar Ventilation – amount of air moved in and out of the alveoli in one minute.

SO WHAT IS TIDAL VOLUME? The lungs are part of the lower airway. The lungs, together with the diaphragm and the muscles of the chest wall, change their internal pressure to pull air in or push air out. The volume of air moved in one in-and-out cycle of breathing is called the tidal volume. We multiply tidal volume by the respiratory rate to obtain minute volume, the amount of air that gets into and out of the lungs in 1 minute. Obviously, minute volume

can be affected by changes in either tidal volume or rate (or both). Remember also that not all of the minute volume of air reaches the alveoli. About 150 mL of a normal tidal volume occupies the space between the mouth and alveoli but does not actually reach the area of gas exchange. We refer to this as dead air space. Alveolar ventilation occurs only with the air that reaches the alveoli.

RESPIRATORY DYSFUNCTION Specific lung diseases and dysfunctions will be discussed later in “Respiratory Emergencies.” However, in general, a respiratory dysfunction occurs any time minute volume is interfered with. •

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DISRUPTION OF RESPIRATORY CONTROL. A section of the brain called the medulla oblongata is the seat of respiratory control. From time to time, disorders that affect this portion of the brain can interfere with respiratory function. Medical events like stroke and infection can disrupt the medulla’s function and alter the control of effective breathing. Toxins and drugs like narcotics can also affect the medulla’s capabilities and adversely impact minute volume. Brain trauma and intracranial pressure can physically harm the medulla and disrupt its function. Even with an intact brain, messages must make their way to the muscles of respiration. Spinal cord injuries and other neurologic disorders can interrupt these transmissions.

UNIT 1 •

DISRUPTION OF PRESSURE. The thorax is essentiallyDAY a 4 vault. The large muscle called the diaphragm forms its lower boundary just below- the rib cage. The lungs arc encased by the chest walls, where ribs are separated by intercostals muscles that contract and relax to create the motion of breathing. The lungs are in direct contact with the inner walls of the chest. Although they are in contact, there is a slight space between the lung tissue and chest wall called the pleural space. There is typically a small amount of fluid in this space between the lung and chest wall. This fluid both lubricates the space to reduce the friction of movement and helps the lung to adhere to the inside of the chest wall. However, this area between the lung and the chest wall is also a potential space where blood and air may accumulate. Ventilation is activated in changing pressures within (his vault. Inhalation is an active process. To inhale, the diaphragm contracts, the muscles of the chest expand, and a negative pressure is created in the lungs. This negative pressure pulls air in through the trachea. By contrast, exhalation is a passive process. To exhale, those same muscles relax to make the chest contract, creating a positive pressure that pushes air out. These changing pressures rely on an intact chest compartment. If a hole is created in the chest wall and air is allowed to escape or be drawn in. the pressures necessary for breathing can be disrupted and minute volume impaired. Furthermore, if bleeding develops within the chest, blood can accumulate in the pleural space and force the lung to collapse away from the chest wall. This can also occur if a hole in either the lung or the chest wall (or both) allows air to accumulate between the lung and the chest wall.

•

DISRUPTION OF LUNG TISSUE. Besides changing the actual amount of air moved per minute, lung function can also be interfered with by disrupting the lung tissue itself. Obviously, trauma is the chief culprit. When lung tissue is displaced or destroyed by mechanical function, it cannot exchange gas. Keep in mind, however, that medical problems can also disrupt lung tissue. For example, medical problems such as congestive heart failure and sepsis change the ability of the alveoli to transfer gases across their membranes. Diffusion of gas is altered and when this happens, the blood in the alveolar capillaries can neither receive oxygen nor off load carbon dioxide normally or at all. The result of any of these challenges is low oxygen (hypoxia) and high carbon dioxide (hypercapnia) within the body. The more the challenge interferes with the movement of air, the more the significant the disruption in oxygenation and ventilation.

FOUNDATION OF EMT PRACTICE

RESPIRATORY COMPENSATION

Chemoreceptor detect changing O2 and CO2 levels. Brain stimulates respiratory system to increase rate and/or tidal volume. There are Three Types of receptors within the lungs which provide RESPIRATORY COMPENSATION impulses to regulate respiration

1. Irritant receptors – found in O2 the airways and are sensitive to Chemoreceptor detect changing and CO2 levels. Brain stimulates respiratory system to increase rate and/or tidal volume. There are Three Types of reirritating gases, aerosols and particles. ceptors withinreceptors the lungs– found whichin provide to the regulate respiration 2. Stretch smoothimpulses muscle of airways

and measure the size and volume of the lungs Irritant receptors – found in the airways and are to irritating 3.1.J-receptors – found in the capillaries surrounding the sensitive algases, aerosols particles. veoli, sensitive to and increase in pressure in the capillary.

2. Stretch receptors – found in smooth muscle of the airways and meas-

ure the the respiratory size and volume lungsby any of the When systemofisthe affected 3. J-receptors – founddiscussed, in the capillaries challenges we have already the bodysurrounding attempts to the alveoli, sensitive to increase indeficits. the capillary. compensate for the in gaspressure exchange Specific sensors in the brain and vascular system register low oxygen levels and high When respiratory system is affected by send any of the challenges we have alcarbonthe dioxide levels. These chemoreceptors messages to ready discussed, the body attemptsNormally, to compensate for the the brain that assistance is required. respiration or gas exchange deficits. Specific sensorsisintriggered the braininand vascular system register the need to breathe the brain by changing carbonlow oxygen levels and high carbon dioxide levels. These chemoreceptors send messages to the dioxide levels. When carbon dioxide levels are increased, the brain assistance is required.system Normally, respiration brain that stimulates the respiratory to take a breath,or in the a need to breathe is triggered in the when brain the by changing levels. When carbon dioxide similar fashion, respiratorycarbon systemdioxide is challenged, levels are increased, the braingas stimulates to take a chemoreceptors sense changing levels andthe sendrespiratory messages tosystem the breath, in a similar fashion, when the respiratory system is challenged, chemobrain. The brain then stimulates the respiratory system to increase receptors sense changing gas levels and send messages to the brain. The brain rate and/or tidal volume. From a patient assessment standpoint, then stimulates the respiratory system to increase rate and/or tidal volume. the most obvious sign of these changes is an evident increase in From a patient assessment standpoint, the most obvious sign of these changes respiratory rate. The respiratory system moves air in and out. but is an evident increase in respiratory rate. The respiratory system moves air in to perfuse cells the air that is breathed in must be matched up and out. but to perfuse cells the air that is breathed in must be matched up with blood. blood. The has been with The cardiovascular cardiovascularsystem systemmoves movesblood bloodthat that has been oxygenated oxygenated passes by the alveoli theprovide cells tothe provide the half of the cardioas it passes as byitthe alveoli to the cellstoto second second half equation. of the cardiopulmonary equation. pulmonary

RESPIRATORY CENTERS IN THE BRAINSTEM

RESPIRATORY CENTERS IN THE BRAINSTEM 1. 2. 3. 4.

1. Dorsal Respiratory Group (DRG)

Dorsal Respiratory Group (DRG) 2. Ventral Respiratory Group (VRG) Ventral Respiratory Group (VRG) 3. Apneustic Center Apneustic Center 4. Pneumotaxic Center Pneumotaxic Center

PROBLEMS WITH THE CARDIOVASCULAR AND RESPIRATORY SYSTEMS 1. Trauma a. Rib Fracture b. Flail Chest c. Sternal Fracture d. Pneumothorax and Hemothorax e. Pulmonary Contusion f. Traumatic Asphyxia g. Diaphragmatic Injury

2. Developmental and Genetic Disorders a. Cystic Fibrosis 3. Effects of Aging on the System

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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DAY 4 TRANSPORT OF OXYGEN AND CARBON DIOXIDE

VENTILATIONDay / 4PERFUSION (V/Q) RATIO – describes the dyFUNDAMENTALS OF PATHOPHYSIOLOGY namic relationship between the amount of ventilation the alveoli receive and the amount of perfusion through the capillaries surrounding the alveoli.

VENTILATION / PERFUSION (V/Q) RATIO – describes the dynamic relationship between the amount of ventilation the alveoli receive and the amount of perfusion through the capillaries surrounding the alveoli. TRANSPORT OF OXYGEN AND CARBON DIOXIDE

TRANSPORT OF OXYGEN AND CARBON DIOXIDE UNIT 1 DAY 4

FOUNDATION OF EMT PRACTICE

CARDIOVASCULAR DISEASES AND DISORDERS Common Diseases of the Cardiovascular System a. Diseases of Arteries b. Diseases of the Heart c. Diseases of the Veins Trauma a. Hemorrhage b. Pericardial Tamponade c. Blunt Cardiac Injury UNIT 1 d. Great Vessel Injury CARDIOVASCULAR DISEASES AND DISORDERS DAY 4 Developmental Diseases and Disorders Common Diseases the Cardiovascular System Septal Defect a. Diseases of Arteriesa.ofAtrial b. Ventricular Septal Defect b. Diseases of theof Heart a. Diseases Arteries c. Diseases of the of Veins c. Patent b. Diseases the HeartDuctus Arteriosus d. Coarctation of the Aorta c. Diseases of the Veins

CARDIOVASCULAR DISEASES AND DISORDERS FOUNDATION OF EMT PRACTICE • Common Diseases of the Cardiovascular System

ASTRIAL SEPTAL DEFECT

• Trauma

Trauma a. Hemorrhage b. Pericardial Tamponade a. Hemorrhage c. Blunt Cardiac Injury b. Pericardial Tamponade d. Great Vessel Injury c. Blunt Cardiac Injury

• Developmental Diseases and Disorders d. Great Vessel Injury

a. Atrial Septal Defect Developmental Diseases and Disorders b. Ventricular Septal Defect a. Atrial Septal Defect c. Patent Ductus Arteriosus d. Coarctation of the Aorta Defect b. Ventricular Septal FOUNDATION OF EMT PRACTICE c. Patent Ductus Arteriosus Coarctation of the Aorta TETRALOGY VENTRICULAR SEPTALd.DEFECT

OF FALLOT

PATENT DUCTUS ARTERIOUSUS

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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² Limmer (Brady) ³ Pollack, (AAOS)

NHTSA PREHOSPITAL⁴EMERGENCY CARE

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

Blood is the vehicle by which oxygen and carbon dioxide are transported. The liquid portion of blood is called plasma. Other components include red blood cells thatplasma contain oxygen-carrying haemoglobin, white blood cells that fight inBlood contains large proteins, which lend to attract fection, and platelets that form clots. Blood transports oxygen by binding it to water away from the area around body cells and pull it into the hemoglobin in This red Wood and.plasma to a lesser extent, the bloodstream. force iscells called oncotic pres-by dissolving it into the plasma. dioxide is alsobydissolved into created the plasma. sure. ItCarbon is counter balanced the pressure inside

THE BLOOD

the vessels when the heart beats. This pressure tends to push fluidParts; back out of the blood vessels toward the cells 1. Four and is called hydrostatic pressure. a. Plasma

PARTSOF OF BLOOD PARTS BLOOD

b. RBC

The balance between the pulling-in force of plasma oncotic pressure and c. WBC hydrostatic pressure is critical to regulating both blood the pushing-out Blood is the vehicle by which oxygen and carbonofdioxide d. Platelets pressure and cell plasma. hydration. A loss or disruption of either of these pressures are transported. The liquid portion of blood is called can be devastating. For example, albumin one of the large proteins in 2. Plasma Oncotic Pressure Other components include red blood cells that contain oxygenplasma, is created in the liver. Liver-failure patients often do not produce carrying haemoglobin, white blood cells that fight infection, and 3. Hydrostatic Pressure enough albumin. Without the pulling-in force of albumin, water freely platelets that form clots. Blood transports oxygen by binding it leaves the bloodstream and accumulates around the body cells, leading to to the hemoglobin in red Wood cellsdehydration and. to a lesser extent, byand massive edema (swelling) in the patient. of the tissue

dissolving it into the plasma. Carbon dioxide is also dissolved into the plasma. Blood plasma contains large proteins, which lend to attract water away from the area around body cells and pull it into 1. Four Parts of the Blood the bloodstream. This force is called plasma oncotic presa. Plasma sure. It is counter balanced by the pressure created inside b. Red blood cells (RBC)the vessels when the heart beats. This pressure tends to c. White blood cells (WBC) push fluid back out of the blood vessels toward the cells d. Platelets and is called hydrostatic pressure.

The balance between the pulling-in force of plasma oncotic pressure and the pushing-out of hydrostatic pressure is critical to regulating both blood pressure and cell hydration. 2. Plasma Oncotic Pressure The balance between the pulling-in force of plasma oncotic pressure and A loss or disruption of either of these pressures can the pushing-out of hydrostatic pressure is critical to regulating both blood be devastating. For example, pressures 3. Hydrostatic Pressure pressure and cell hydration. A loss or disruption of either of thesealbumin one of the large proteins can be devastating. For example, albumin one of the large proteins in in plasma, is created in the liver. plasma, is created in the liver. Liver-failure patients often do not produce Liver-failure patients often do enough albumin. Without the pulling-in force of albumin, water freely not produce enough albumin. Blood plasma contains large proteins, which leaves the bloodstream and accumulates around the body cells, leading Without to the pulling-in force of lend to attract water away from the area around dehydration of the tissue and massive edema (swelling) in the patient. albumin, water freely leaves the body cells and pull it into the bloodstream. This bloodstream and accumulates force is called plasma oncotic pressure. It is around the body cells, leading counter balanced by the pressure created inside to dehydration of the tissue and the vessels when the heart beats. This pressure tends to push massive edema (swelling) in the fluid back out of the blood vessels toward the cells and is called ² Limmer (Brady) patient. ³ Pollack, (AAOS) hydrostatic pressure. ⁴ NHTSA

BLOOD DYSFUNCTION The most common blood dysfunctions relate to volume. You simply have 10 have enough blood to accomplish the goals of moving oxygen and carbon dioxide. Bleeding obviously defeats this goal, as does dehydration. Other blood dysfunctions arc caused by conditions that affect the components of the blood. Certain types of anemia decrease (he number of red blood cells, which decreases the blood’s ability to carry oxygen. Other conditions (like liver failure) affect waterretaining proteins in the blood (such as albumin), causing a decrease in volume.

THE BLOOD VESSELS ² Limmer Blood is distributed throughout the(Brady) body, then returned ³ Pollack, (AAOS) to the heart, by a network of blood ⁴vessels. Arteries, veins, and NHTSA capillaries form this network. Arteries carry blood away from the heart. Artery walls arc composed of layers, and arteries can change diameter by contracting their middle layer of smooth muscle. Veins carry blood back to the heart and also can change diameter with a layer of smooth muscle. Arteries carry oxygenated blood while veins carry deoxygenated blood. The only exceptions to this rule are the pulmonary arteries (they carry deoxygenated blood from the heart to the lungs) and the pulmonary veins (they carry

oxygenated blood from the lungs to the heart). As blood leaves the heart, it travels through arteries, whose diameter decreases as they approach the cellular level, eventually reaching the smallest arteries, known as arterioles. Arterioles then feed the oxygenated blood into tiny vessels called capillaries. Capillaries have thin walls, like cell membranes, that allow for movement of substances into and out of the bloodstream. Through these thin capillary walls oxygen is offloaded and carbon dioxide is picked up from the cells of the body. Capillaries then connect to the smallest veins, called venule. Venules turn into veins as they grow larger, and veins transport blood back to the heart. A similar process takes place in the lungs, but it is reversed from the process that happened at the level of the body cells. Deoxygenated blood that has been returned to the right side of the heart is pumped to the lungs via the pulmonary arteries and arterioles. The pulmonary arterioles connect with pulmonary capillaries that surround the alveoli, the tiny air pockets in the lungs. Carbon dioxide is off-loaded from the capillaries across the alveolar membrane to the alveoli to be exhaled from the lungs. Oxygen is transferred from the air in the alveoli across the alveolar membrane and into the surrounding capillaries. The newly oxygenated blood then continues on its way from the pulmonary capillaries to the pulmonary venules and into the pulmonary veins. The pulmonary veins return the oxygenated blood to the left side of the heart, which pumps it out to the body. The movement of blood through the blood vessels depends on LIFELINE

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blood vessels occurs with their inability to control their diameter. If blood vessels arc unable to constrict when UNIT 11 UNIT CRITICAL CONCEPT necessary or, worse, if they are forced BLOOD VESSEL DYSFUNCTION UNIT DAY 41 4 DAY into an uncontrolled dilatation, interDAY 4 FUNDAMENTALS OF PATHOPHYSIOLOGY The heart pump with strok nal pressure seriously drop. Many Day 4 can  Loss of Tone. A major problemconditions with (output) of about 60ml blood can cause this loss of tone. traction. A Stroke Volume is blood vessels occurs with their Injuries inabil- to the brain and spinal cord pressure in the system. For the leading blood molecule to get where Preload, the amount of blood ity to control their diameter. If can blood cause uncontrolled dilation of the it is going, it must have other molecules behind it, pushing it along to heart, Contractility is how h BLOOD VESSEL DYSFUNCTION vessels(normal arc unable to constrictVESSEL when DYSFUNCTION blood vessels Systemic pressure). BLOOD If the molecules are too spread out. (vasodilation). there is no squeezes and Afterload whi DYSFUNCTION NCTION necessary worse, ifmolecule, they are forced push or, on that leadingBLOOD andVESSEL it does not move (low pressure). infections (sepsis} can also cause vespressure in vessels will discuss the heart’s role in creating the needed pressureallergic later into anWeuncontrolled dilatation, intersel dilation. Severe reactions  Loss of Tone. A major problem with  Loss of Tone. A major problem with in the chapter, but one factor besidesMany the heart that helps determine nal pressure can seriously drop. also can similar problems.  vessel Loss Tone. Acause major problem with blood vessels occurs with their inabilwithin a blood is of its size or, more specifically, the blood vessels occurs with their inabiloblemconditions with pressure can cause this loss of tone. vessel’s diameter. blood vessels occurs with their inability to control their diameter. If blood ity to control their diameter. If blood CARDIAC OUTP heir Injuries inabil- to the brain and spinal cord We noted earlier thatity most change their diameterIf blood tovessels control their to diameter. vessels arccan unable to constrict constrict when vessels arc unable when er. If can blood by using a layer of smooth muscle in the vessel wall. Depending on cause uncontrolled dilation of the vessels arcor, unable to constrict when necessary or, worse, they are forced necessary worse, ififtothey trict blood when the circumstances, vessels will frequently change size adjustare for forced vessels (vasodilation). Systemic Loss of tone – lose ability to constrictFormula: and dilate SV x HR = CO necessary or, worse, if they are forced into an uncontrolled dilatation, interin pressure. In fact, certain blood vessels contain specializedinterinto an uncontrolled dilatation, are infections forced changes (sepsis} can receptors also cause vessensors called stretch that detect the level of internal into an uncontrolled dilatation, internal pressure can seriously drop. Many nal pressure can seriously drop. Many ation,sel interpressure Severe and transmit messages to the nervous system, which thenof Many dilation. allergic reactions nal pressure can seriously drop. conditions can cause this loss tone. conditions can cause this loss of tone. stroke volume X beats per drop.also Many triggers thesimilar smooth muscle in the vessel walls to make any needed can cause problems. conditions can cause this loss of tone. Injuries to the brain and spinal cord Cardiac Output Injuries to the brain and spinal cord oss of tone. size adjustments. Injuries to the brain and spinal cord can cause uncontrolled dilation of the can cause uncontrolled dilation of the Pressure may need to be adjusted for a variety of reasons,  Permeability Certain conditions cause spinal cord including loss of volume blood (blood) invessels the system or too much volume in can cause uncontrolled dilation of the permeblood vessels (vasodilation). Systemic (vasodilation). Systemic capillaries to become overly tion of the the system. blood vessels (vasodilation). Systemic infections (sepsis} can also cause vesinfections (sepsis} can also cause vesable, or "leaky." allowing loo much ). Systemic Loss of(sepsis} tone – can lose ability to constrict and dilate infections also cause vessel dilation. dilation. Severe allergic reactions sel Severe allergic reactions fluid (0 flow out through their walls cause ves- BLOOD VESSEL DYSFUNCTION sel Severe reactions alsodilation. cancause cause similarallergic problems. also can problems. (Figure similar 6-8). Sepsis and certain disc reactions also can cause similar problems. • LOSS OF TONE -- A major problem blood vessels occurscause increases easeswith can frequently ems. with their inability to control their diameter. Ifpermeability. blood vessels are in capillary unable to constrict when necessary or, worse, if they are forced  Permeability Certain conditions cause an uncontrolled dilatation, internal pressure can seriously Lossof oftone tone––lose loseability abilityto toconstrict constrictand anddilate dilate Loss capillariesinto to become overly permeLoss of tone – lose ability to constrict and dilate drop. Many conditions can cause this loss of tone. Injuries toLoss the of tone – lose ability to constrict and dilate able, or brain "leaky." allowing andability spinal cord can loo cause much uncontrolled dilation of the blood Loss of tone – lose to constrict and dilate vesselsout (vasodilation). Systemic fluid (0 flow through theirinfections walls (sepsis} can also cause vessel dilation. reactions Permeability – capillaries leak fluid out their walls (Figure 6-8). Sepsis Severe and allergic certain dis- also can cause similar problems. cause Permeability Certain conditions conditions cause cause Permeability eases can frequently increasesCertain -- Certain Permeability conditions cause capillaries toCertain become overly perme“ capillaries to become overly in capillary permeability. • PERMEABILITY conditions cause capillaries to be- perme“leaky.” Hypertension The inside the ions cause come overly permeable, capillaries to become overly permeable, or "leaky." allowing loo much or allowing too much fluidpressure to flow able, or "leaky." allowing loo much vessels that the diseases heart (Figure 6-8). Sepsis and certain rly perme- out through their walls able, or "leaky." allowing loo has much fluid (0 flow out through their wallsto pump fluid (0 flow out through their walls can frequently cause increases in capillary permeability. against is called systemic vascular resisloo much fluid (0 6-8). flow out through their walls (Figure 6-8). Sepsis Sepsis and certain certain dis(Figure and distance (SVR), Normally, thisdispressure is (Figure 6-8). Sepsis certain their walls • HYPERTENSION -- The eases can frequently cause increases eases can frequently cause increases pressure inside the vesselsand that the heart an important factor in moving blood. eases can frequently cause increases in capillary permeability. Permeability – capillaries leak fluid out their walls certain dis- has to pump against isin called systemic vascular resistance (SVR), capillary permeability. However, some blood. patients, the presan important factorin in moving permeability. e increases Normally, this pressureiniscapillary However, in some patients, thesure pressure abnormally increased. is isabnormally increased. Chronic Chronic smoking, certain drugs, andthe even genetics can cause an  Hypertension The pressure inside smoking, certain drugs, abnormal constriction of the peripheral blood vessels and. there- and even gevessels that the heart has tonetics pump canincreased cause pressure an abnormal constricfore, an unhealthy high pressure level. Tin’s can Permeability capillariesleak leakfluid fluidout outtheir theirwalls walls Permeability ––capillaries against isbecalled vascular a majorsystemic risk factor in heart disease and tionresisof stroke. the peripheral blood vessels Permeability – capillaries leak fluid out their walls tance (SVR), Normally, this pressure is and. therefore, an unhealthy highPermeability – capillaries leak fluid presPermeability – capillaries leak fluid out their walls an important factor  in moving blood. out their walls sure level. Tin's increased pressure can Hypertension The The pressure pressure inside inside the the  Hypertension However, in some patients, the presa major risk factor in pump heart  vessels Hypertension The pressure the disease vesselsbe that the heart has inside to pump that the heart has to sure is abnormally increased. Chronic vessels that the heart has to pump against is called systemic vascular resisand stroke. against is called systemic vascular resise inside the certain drugs, and even gesmoking, against is called systemic vascular resistance (SVR), (SVR), Normally, this pressure tance Normally, this pressure isis s tonetics pumpcan cause an abnormal constrictance (SVR), Normally, this pressure is an important factor in moving blood. an important factor in moving blood. ascular resistion of the peripheral However, blood vessels an important factor in moving blood. However, in some patients, the presin some patients, the prespressure is and. therefore, an unhealthy presHowever, in some increased. patients, pressurehigh abnormally increased.the Chronic sure isis abnormally Chronic vingsure blood. level. Tin's increasedsmoking, pressure can sure is abnormally increased. Chronic smoking, certain drugs, and even gecertain drugs, and even ges, the be presa major risk factor innetics heartcan disease smoking, certain drugs, and even genetics can cause an abnormal constriccause an abnormal constriced. Chronic Systemic Vascular Resistance (SVR) – pressure inside vessels and stroke. netics cause an abnormal tion of ofcan the peripheral bloodconstricvessels tion the peripheral blood vessels Systemic Vascular Resistance (SVR) – pressure inside vessels nd even getion of the peripheral blood vessels and.therefore, therefore, anunhealthy unhealthy high presand. an high presmal constricand. therefore, unhealthy high pressure level. level. Tin's Tin'san increased pressure can sure increased pressure can ood vessels sure increased pressure can be aa level. majorTin's risk factor factor in in heart heart disease be major risk disease y high presbe major andCARE stroke. and stroke. ²aLimmer (Brady)risk factor in heart disease PREHOSPITAL EMERGENCY pressure 120 can LIFELINE (AAOS) and⁴³ Pollack, stroke. NHTSA eart disease Systemic Vascular Resistance (SVR) – pressure inside vessels

FOUNDATION OF EMT EMT PRACTICE FOUNDATION TION OF EMT PRACTICE FOUNDATION OF OF EMT PRACTICE PRACTICE

ke volume d per conbased on returning hard heart ich is the

PUT

O minute =

THE HEART The heart is the key to cardiovascular function. The movement of blood and the resulting transportation of oxygen and carbon dioxide depend on the heart working properly.

THE HEART

At its most basic level, the heart is a pump. Its job is very straightforward: to move blood. To do this, it mechanically contracts and ejects blood. The volume of heart in is the to cardiovascular The movement and the resulting bloodThe ejected onekey squeeze is known function. as the stroke volume. of Anblood average person transportation of oxygen carbon dependStroke on the heart working properly. ejects roughly 60 mL ofand blood perdioxide contraction. volume depends on a series of factors: At its most basic level, the heart is a pump. Its job is very straightforward: to move blood. To do this, it mechanically contracts and ejects blood. The volume of blood ejected in one  Preload is how returned lo the ejects heartroughly prior to contracsqueeze is known as themuch strokeblood volume.isAn average person 60 the mL of blood per tion; inStroke othervolume words, how much it isoffilled. The greater the filling of the contraction. depends on a series factors: heart, the greater the stroke volume. • Preload is how much blood is returned lo the heart prior to the contraction; in other words, how much it is force filled. The the filling of the greater stroke  Contractility is the of greater contraction; that is. heart, how the hard thetheheart volume. The more forceful the muscle squeezes, the greater the stroke squeezes. volume. • Contractility is the force of contraction; that is. how hard the heart squeezes. The more forceful the muscle squeezes, the greater the stroke volume.  Afterload is a function of systemic vascular resistance. It is how much presthe heart has toofpump against in resistance. order to It force blood into the the • sure Afterload is a function systemic vascular is how muchout pressure system. The greater the in pressure theblood system, thethe lower theThe stroke volheart has to pump against order to in force out into system. greater the ume. pressure in the system, the lower the stroke volume.

CRITICAL CONCEPTS The heart pumps with stroke volume (output) of about 60 ml of blood per contraction. A stroke volume is based on preload, the amount of blood returning to the heart. Contractility is how hard the heart squeezes and afterload is the pressure in the vessels. CARDIAC OUTPUT Formula: SV x HR = CO Stroke volume x Beats per minute = Cardiac output

Sa bawat pagtibok ng puso ay bumobomba ito ng 60 ml na dugo. Tinatawag itong stroke volume. Kinukuwenta ito base sa preload o yung dami ng dugo na pabalik sa puso. Nasusukat din kung gaano kadiin kung tumibok ang puso sa pamamagitan ng presyon sa mga ugat.

HEART DYSFUNCTION Heart dysfunctions can be either mechanical or electrical. we discussed lungswe wedetermined determined the They can a result of a WhenWhen we discussed thethe lungs the minute volume bybemultiplying minute by (amount multiplying volume in (amount structural problem or the tidalvolume volume ofthe airtidal breathed per respiration) by themuscle respiratory of air breathedofinrespirations per respiration) the respiratory rate result of a problem rate (number in 1byminute). Cardiac output, likethe minute volume, is awith the (number of respirations in 1 minute). Cardiac output, electrical stimulation per-minute measurement and is calculated in a similar fashion. Cardiac output of is that like minute volume, is a per-minute measurement and muscle. Mechanical problems determined by examining the stroke volume (amount of blood ejected in one is calculated in a similar fashion. Cardiac output is include physical trauma (like beat) and the rate the (number of beats in 1 minute). In other tostab calcudetermined by heart examining stroke volume (amount of bullet words holes and wounds), late cardiac output, you would strokeofvolume bysqueezing the heart rate. blood ejected in one beat) and themultiply heart ratethe (number forces (like when beats in 1 minute). In other words to calculate cardiac the heart is compressed by Just like you minute volume, output canbybe cither part output, would multiplycardiac the stroke volume theaffected heart by changes bleeding to inside its protective ofrate. the equation. Either slowing the heart rate or decreasing the stroke pericardial sac),volume or loss of will decrease cardiac output. Cardiac output can also be impacted by heart rates from cardiac muscle function Justtoo likefast. minute volume,increasing cardiac output canrate be affected (hat are Although heart would normally increase cell death (as incardiac a heart attack). by changes cither part(usually of the equation. slowing problems output, verytofast rates >180 inEither adults) limit the fillingElectrical of the heart andtypically in thedecrease heart rate stroke or decreasing the stroke volume will decrease occur from diseases such as fact volume. cardiac output. Cardiac output can also be impacted by heart attacks or heart failure heart rates that are too fast.system Although increasing that damage the electrical The autonomic nervous also plays a heart largerate role in adjusting cardiac outwould normally increasenervous cardiac output, very fast rates systemincreases of the heart. These put. The sympathetic system's "fight-or-flight" response heart (usually >180 in adults) limit the filling of the heart and in cardiac electrical problems rate and the strength of heart muscle contraction. The parasympathetic nervous fact decrease stroke volume. include unorganized rhythms. system slows the heart down and decreases contractility. On an ongoing basis, it such as ventricular fibrillation, is the The heart that creates the pressure in the cardiovascular system. Without its autonomic nervous system also plays a large role and rate problems, such as pumping force, blood does not move. in adjusting cardiac output. The sympathetic nervous bradycardia and tachycardia. system’s “fight-or-flight” response increases heart rate In infants and children, and the strength of heart muscle contraction. The bradycardia is often the parasympathetic nervous system slows the heart down result of acute hypoxia from ² Limmer (Brady) decreases contractility. On an ongoing basis, it is the inadequate ventilation rather ³and Pollack, (AAOS) ⁴heart NHTSA that creates the pressure in the cardiovascular system. than from a primary cardiac Without its pumping force, blood does not move. cause, LIFELINE

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Fluid Loss (dehydration) – decrease in total water volume

Day 4

CRITICAL CONCEPTS FLUID DISRUPTION Fluid Loss (dehydration) – decrease in total water volume Fluid distribution – water not getting to where it’s needed Edema – too much water in some parts of the body

FUNDAMENTALS OF PATHOPHYSIOLOGY

CARDIOPULMONARY SYSTEM: PUTTING IT ALL TOGETHER

Fluid distribution – water not getting to where it’s needed Edema – too much water in some parts of the body

Now that you have had an opportunity to explore what really happens in the cardiopulmonary system, you may see just how important to understand the big picture. For the system to do its job, all of the components must be doing theirs. In the respiratory system, air movement must bring oxygen all the way to the alveoli and move carbon dioxide back all the way out; there must be a significant quantity of air moving, and the alveoli must be capable of exchanging gas. In the cardiovascular system, there must be enough blood: the heart must adequately pump the blood, and there must he enough pressure in the system to provide perfusion throughout the body—that is, to move the blood between the alveoli and the body cells and between the body cells and the alveoli. Furthermore, the blood must be capable of carrying oxygen and carbon dioxide. When all these functions are in place we have what is called a ventilation/perfusion match, otherwise known as a V/Q match. What this implies is that the alveoli have sufficient air and that air is matched up with sufficient blood in the pulmonary capillaries. V/Q matching is rarely perfect. In fact, even in healthy lungs a force as simple as gravity can mean that alveoli in the upper areas of the lungs may not be matched with as much blood as alveoli in the lower areas. As a result, we often express the V/Q match as a ratio rather than a true match. The V/Q ratio can “ be disrupted by any challenge that interferes with any element of the cardiopulmonary system. Minute volume problems, cardiac output problems, and structural damage to the lungs all can disrupt the match between, air and blood.

Halos 60 porsiyento ng katawan ng tao ay binubuo ng tubig, at kung wala ito, hindi mabubuhay ang mga bahagi ng katawan. Ang tubig ay makikita sa kabuuan ng katawan -mula sa loob hanggang sa labas -- at ang pagbalanse sa tubig sa katawan ng tao ang susi para sa maayos na kalusugan.

SHOCK Shock occurs when a V/O mismatch happens. As we noted previously, all cells require regular delivery of oxygen and nutrients and removal of waste products. This is a function of a regular supply of blood and is referred to as perfusion. Shock occurs when perfusion is inadequate. Inadequate perfusion is referred to as hypoperfusion, which is considered to be a synonym for shock. In other words, shock occurs when the regular delivery of oxygen and nutrients to cells and the removal of their waste products is interrupted. Without a regular supply of oxygen, cells become hypoxic and must rely on anaerobic metabolism. When this type of metabolism occurs, lactic acid and other waste products accumulate and harm the cells. Without the removal of carbon dioxide, the build up of harmful waste products is accelerated. Unless it is reversed, shock will kill cells, organs, and eventually the patient.

WHAT YOU NEED TO LEARN 1. Classification of Shock a. Hypovolemic Shock b. Cardiogenic Shock c. Neurogenic Shock d. Vasogenic Shock

2. Assessment of Shock 3. Age-Related Differences in Shock

PATHOPHYSIOLOGY OF OTHER SYSTEMS FLUID BALANCE About 60 percent of the body is made up of water, and without this fluid the functions of cells would cease. Water is distributed throughout the body, both inside and outside the cells and balancing this distribution is an important part of maintaining normal cellular function.

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Cardiogenic Shock Neurogenic Shock Vasogenic Shock 2. Assessment of Shock 3. Age-Related Differences in Shock

PATHOPHYSIOLOGY OF OTHER SYSTEMS FLUID BALANCE RECOGNIZING

COMPENSATION

About 60 percentWhen of theabody made up occurs, of water,the and without this fluid the V/Q ismismatch body compensates in functions ofpredictable cells would ways. cease. Commonly, Water is distributed throughout the body, both the autonomic nervous system inside and outside the cells and balancing this distribution is an important part of engages the “fight-or-flight” mechanism of its sympathetic arm. maintaining normal cellular function.

This causes blood vessels to constrict and the heart to beat faster and stronger. The sympathetic nervous response also causes pupils RECOGNIZING COMPENSATION to dilate and the skin to sweat. Chemoreceptors in the brain and vessels sense carbon dioxide and hypoxia and When a V/Qblood mismatch occurs, theincreasing body compensates in predictable ways. Commonly, the autonomic system engages "fight-or-flight" of The stimulate nervous the respiratory systemthe to breathe fastermechanism and deeper. its sympathetic arm. This causes blood vessels to constrict and the heart apparent. to beat signs and symptoms ol these changes are often readily faster and stronger. The sympathetic nervous response also causes pupils to diLook for increased pulse and respirations. You may note delayed late and the skin to sweat. Chemoreceptors in the brain and blood vessels sense capillary refilland andhypoxia pale skin. may dilated and the patient increasing carbon dioxide andPupils stimulate theberespiratory system to may bedeeper. sweatyThe even in cool environments. breathe faster and signs and symptoms ol these changes are often readily apparent. Look for increased pulse and respirations. You may note delayed capillary refill and pale you skin.may Pupils may be dilated and the the patient may be Although not know exactly what nature sweaty even in cool environments.

of the V/Q mismatch is, recognizing these common signs of

compensation will help what you identify thatofthe exists. Although you may not know exactly the nature themismatch V/Q mismatch is, these signs serve as will a red flagyou when youthat assess recognizingEach these of common signs should of compensation help identify the your mismatch exists. Eachlearn of these signs should a red flag when you patient, to recognize theserve signsasof compensation as assess a warning your patient,that learn to body recognize the signs of compensation as a warning the the is dealing with a challenge. Consider thatthat these body is dealing with point a challenge. that important these findings out thatmay findings out thatConsider something andpoint dangerous something important and dangerous may be taking place. Normally, water is be taking place.inNormally, is divided threereprespaces in divided among three spaces the body, water with the followingamong percentages the body, with the following percentages representing averages: senting averages:  Intracellular (70 percent)—This is water that is inside the cells,  Intravascular (5 percent)—This is water that is in the bloodstream.  Interstitial (25 percent)—This water can be found between cells and blood vessels.

DISRUPTIONS OF FLUID BALANCE • Fluid Loss. Dehydration is an abnormal decrease in the total

amount of water in the body. This may be caused by a decreased fluid intake or a significant loss of fluid from the body by one or more of a variety of means. Remember, however, that maintaining a balance of water relies on a healthy gastrointestinal system. Severe vomiting or diarrhea can also significantly alter the amount of water in the body. Fluid can he lost, as well, through rapid breathing (as in a respiratory distress patient) and profuse sweating. The plasma portion of blood can be lost with injuries such as burns.

• Fluid Distribution. Sometimes the body has enough water but

cannot get it to where it needs to go. Certain disease processes interfere with the body’s mechanisms of moving fluid. We discussed previously the loss of proteins in blood from liver failure and the changes in capillary membrane permeability that occur with severe infections. In these cases, water migrates out of the bloodstream and cells and into the interstitial space (where it is much less useful). Often this can be seen in the form of edema.

• Edema is swelling associated with the movement of water. Edema can be seen best in dependent parts of the body; that is. those parts most subject to gravity such as the hands, feet, and legs. Edema can also occur because of an injury (for example, when your thumb swells up after hitting it with a hammer). In this case, the injury has altered the permeability of local capillaries and fluid has shifted. The larger the injury, the more the fluid shifts. Occasionally, fluid can be shifted by changing pressures inside the blood vessels. When pressure is high, the tendency will he to move the fluid portion of the blood out. This can be seen in disorders like acute pulmonary edema.

THE NERVOUS SYSTEM ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

• • •

Intracellular (70 percent)—This is water that is inside the cells, Intravascular (5 percent)—This is water that is in the bloodstream. Interstitial (25 percent)—This water can be found between cells and blood vessels.

We regulate the levels of water in our body by drinking fluids and making/ excreting urine. This .allows us to constantly adjust our hydration based on our levels of activity. Inside our bodies, fluid is distributed appropriately through a number of factors: • • •

The brain and kidneys regulate thirst and elimination of excess fluid. The large proteins in our blood plasma pull fluid into the bloodstream, The permeability of both cell membranes and the walls of capillaries help determine how much water can be held in and pushed out of cells and blood vessels.

It is important to note that almost all body functions are regulated by the brain and the spinal cord. The brain is the control center and the spinal cord is the messenger. Trauma or disease to either of these organs can be devastating to body functions. The brain and spinal cord are well-protected by bone and muscle. Additionally, they are covered by protective layers called meninges. They are further defended by a layer of shock absorbing fluid called cerebrospinal fluid. Although they are well protected, the brain and spinal cord function can be damaged by trauma or disease.

Each of these factors helps us regulate Ihc amount and distribution of fluid. If these factors were to be interfered with, fluid levels and distribution can become problematic. LIFELINE

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FUNDAMENTALS OF PATHOPHYSIOLOGY

NERVOUS SYSTEM DYSFUNCTION Trauma Despite all their defenses, occasionally the brain and spinal cord are subjected to forces that injure them. Motor vehicle crashes, falls, and diving accidents can all cause injury to this system. In the brain, mechanical damage will interrupt the function of the area that has been harmed. For example, injuries to the area that controls speech will result in an inability to speak or to speak normally. Because the brain is enclosed in the cranial vault, bleeding and swelling also are a concern. Since the skull is a closed container, blood or edema takes up space where brain tissue would otherwise be and presses on the brain. Blood pressure inside the vault (intracranial pressure) can also be increased, and this pressure can damage additional structures and alter functions as well. Mechanical damage to the spine and other nervous pathway’s results in disruption of nervous system communication. When we think of severing the spinal cord, paralysis comes to mind. However. remember that, beyond motor function, the patient also loses sensory and autonomic messaging. That means when a nervous pathway is destroyed, movement, sensation, and even automatic functions like breathing and blood vessel dilation may be altered. As in the brain, bleeding and edema arc also threats in the closed container of the spinal column.

Medical Dysfunction Medical problems, both acute and chronic, can alter nervous system function. Strokes result from clots and bleeding in the arteries that perfuse the brain. In these cases, brain cells are deprived of oxygen and die. As with trauma, the net result of the damage will depend on the affected area’s function. Diseases can also affect the brain and spinal cord. Meningitis, an infection of the protective layers of the brain and spinal cord; encephalitis, an infection of the brain itself: and a variety of diseases that affect the nerves, such as Lou Gehrig’s disease and multiple sclerosis, all can impair the transmission of messages in the nervous system. General medical problems can also affect normal brain function: for example, a diabetic with low blood sugar (hypoglycemia) who becomes confused and eventually unresponsive when his brain is deprived of the glucose it needs for proper functioning,

Signs of neurologic impairment • • • • • • • •

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Altered mental status Inability to speak or difficulty speaking Visual or hearing disturbance Inability to walk or difficulty walking Paralysis (sometimes limited to one side) Weakness (sometimes limited to one side) Loss of sensation (sometimes limited to one side or area of the body) Pupil changes

PREHOSPITAL EMERGENCY CARE

NEUROLOGICAL DISEASES AND DISORDERS • • • •

Common diseases of the nervous system are infectious diseases, vascular disorders, functional disorders, dementia, altered mental status and tumors. Trauma causes are skull fractures, diffuse axonal injury, focal brain injuries and spinal cord injury. Medical problems that affect the central nervous system are strokes, infection (meningitis, encephalitis), diseases (Lou Gehrig’s disease) and low blood sugar (hypoglycemia). Genetic and developmental disorders of the central nervous system includes cerebral palsy and spina bifida.

ENDOCRINE SYSTEM The endocrine system is made up of a variety of glands that secrete chemical messages in the form of hormones. These hormones dictate and control a variety of body functions, such as glucose transfer and water absorption in the kidney’s among many others. The major organs of this system include the kidneys and the brain. The endocrine system also includes several glands, such as the pancreas and the pituitary, thyroid, and adrenal glands.

ENDOCRINE SYSTEM DYSFUNCTION Dysfunctions of the endocrine system are primarily the result of organ or gland problems, Although trauma can cause injury to organs, typically endocrine dysfunctions are either present at birth or the result of illness. Endocrine disorders generally fall into one of the following categories: • TOO MANY HORMONES -- In some disease states, glands produce an excessive amount of hormones. Graves’ disease, for example, is a condition in which the thyroid gland overproduces its hormone. Patients with this condition can suffer from difficulties like regulating temperature and fast heart rates. • NOT ENOUGH HORMONES -- More common are endocrine disorders where glands produces too few hormones. In diabetes, the pancreas does not secrete enough of the hormone insulin. Insulin helps move glucose from our bloodstream into our body cells. Without enough insulin. our cells starve.

ENDOCRINE DISEASES AND DISORDERS a. Thyroid Gland Diseases

i. Hyperthyroidism – too much thyroid hormone

b. Adrenal Gland Diseases c. Disorders of Glucose and Metabolism d. Trauma

UNIT11 UNIT DAY44 DAY

FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE FOUNDATION

THE DIGESTIVE SYSTEM The digestive system consists of the esophagus, stomach, intestines, and a few additional associated organs. The digestive system allows food, water and other nutrients to enter the body. It also controls the absorption of those substances into our bloodstream.

CLEFT LIP

DIGESTIVE DYSFUNCTION Digestive disorders can seriously impact both hydration levels and nutrient transfer. •

GASTROINTESTINAL BLEEDING -- The digestive system is supported by a rich blood supply which enables absorption of nutrients from the digestive tract into the bloodstream, Gastrointestinal (Gl) bleeding can occur anywhere in the digestive tract from the esophagus to the anus. Digestive system bleeding can be slow and chronic or can present with shock from acute massive Needing in the form of rectal bleeding or vomiting blood.

•

VOMITING AND DIARRHEA -- Probably the most common digestive disorders are vomiting and diarrhea. Vomiting and diarrhea arc not diseases themselves, but rather symptoms of other disorders. There are literally hundreds of potential causes, but you should be aware that both can be related to serious problems. Aside from digestive complications, vomiting is often a sign of acute myocardial infarction (heart attack) and stroke. More commonly, however, vomiting and diarrhea are caused by viral or bacterial infection. When isolated, the serious complications of nausea and vomiting include dehydration and malnutrition

CLEFT LIP CLEFT LIP CLEFT LIP

CLEFT PALATE CLEFT PALATE

CLEFTPALATE PALATE CLEFT

GASTROENTEROLOGIC DISEASES AND DISORDERS Common Diseases and Disorders

a. Diseases of the mouth b. Diseases of the throat and esophagus c. Diseases of the stomach d. Diseases of the small intestine e. Diseases of the colon f. Diseases of the rectum g. Gastrointestinal bleeding h. Diseases of the liver i. Diseases of the gallbladder j. Diseases of the pancreas

Trauma

a. Solid Organ Trauma b. Hollow Organ Trauma

Developmental and Genetic Disorder

a. Developmental malformations i. Cleft up and palate ii. Pyloric stenosis iii. Hirschsprung’s disease

PYLORIC STENOSIS ² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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Day 4

FUNDAMENTALS OF PATHOPHYSIOLOGY

THE IMMUNE SYSTEM The immune system is responsible for fighting infection. It responds to specific body invaders by identifying them, marking them, and destroying them. The blood plays a major role in the immune system. Once a foreign body is identified, the body dispatches specialized cells and chemicals. White blood cells and antibodies are transported in the bloodstream lo attack the invaders. This is a normal body response lo infection or invasion by a foreign substance. An allergic reaction or anaphylactic reaction is an abnormally exaggerated version of this response that occurs as a result of a flaw in the immune system.

HYPERSENSITIVITY (ALLERGIC REACTION) An exaggerated immune response is referred to as hypersensitivity (also known as an allergic reaction). Hypersensitivity can occur in a response to certain foods, drugs, animals, or a variety of substances. In a hypersensitivity reaction, the immune system, in responding to These specific substances, releases chemical toxins that cause more of a reaction than necessary. The allergic reaction occurs when these chemicals affect more than just the designated invader. One of the chemicals released, called histamine, produces edema and. in some cases, a narrowing of the airways. Olher chemicals can cause dilation of the smooth muscles of blood vessels, resulting in a rapid drop in blood pressure. Hypersensitivity reactions range from minor and localized reactions to severe and life-threatening ones. Rapid identification and treatment is often lifesaving.

IMMUNE AND LYMPHATIC DISEASES AND DISORDERS Common Diseases of the Immune System a. Hypersensitivity Disorders b. Immune Deficiency Disorders

Common Diseases of the Lymphatic System a. Lymphadenitis b. Lymphangitis c. Lymphedema d. Lymphoma e. Mononucleosis

Trauma and Effects of Aging on the Immune System RENAL AND UROLOGIC DISEASES AND DISORDERS Common Diseases of the Renal and Urologic System a. Urinary Tract Infection (UTI) b. Diseases of the Kidney c. Diseases of the Bladder

Trauma

a. Straddle Injuries b. Neurogenic Bladder

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TOXICOLOGIC EMERGENCIES Routes of Entry a. Ingestion b. Inhalation c. Injection d. Absorption

General Management of Toxicologic Emergencies Substances of Abuse Food Poisoning Insect and Snake Bites HEMATOLOGIC SYSTEM DISEASES AND DISORDERS Common Diseases of the Hematologic System a. Disorders of Red Blood Cells b. Disorders of White Blood Cells c. Disorders of Platelets

Trauma Developmental and Genetic Disorders Effects of Aging on the System INTEGUMENTARY DISEASES AND DISORDERS Common Diseases of the Integumentary System a. Infectious Diseases

Trauma

a. Mechanical Skin Injury b. Thermal Skin Injury c. Electrical Injury d. Radiation Injury e. Pressure Injury

Effects of Aging on the System EYE AND EAR DISEASES AND DISORDERS Common Diseases of the Eye

a. Inflammation and Infection b. Cataract c. Glaucoma

Common Diseases of the Ear a. Infection b. Labyrinthitis

Trauma

a. Corneal Abrasion b. Conjunctival Hemorrhage c. Ruptured Globe d. Orbital Fracture e. Chemical Trauma

g. Retinal Detachment h. Ruptured Tympanic Membrane i. Basilar Skull Fracture j. Separation of Ear Cartilage

ENVIRONMENTAL DISEASES AND DISORDERS 1. Heat Emergencies 2. Physiology of the Thermoregulatory Mechanism a. Fever b. Heat Cramps c. Heat Exhaustion d. Heat Stroke

e. Cold Emergencies f. Hypothermia g. Frostbite

3. Water Emergencies

a. Near Drowning b. Diving Emergencies

4. Altitude Emergencies

a. Physiologic Response to Altitude i. Acute Mountain Sickness ii. High Altitude Cerebral Edema iii. High Altitude Pulmonary Edema

BEHAVIORAL DISEASES AND DISORDERS Common Mental Health Disorders a. Developmental Mental Health Disorders b. Substance Related Mental Disorders c. Organic Mental Disorders d. Psychosis

e. Mood or Affective Disorders f. Dissociative Disorders g. Anxiety Disorders h. Somatoform Disorders i. Personality Disorders

Trauma Mental Health Disorders in the Older Adult

REPRODUCTIVE DISEASES AND DISORDERS Common Disease of the Reproductive System a. Female Reproductive System Diseases b. Male Reproductive System Diseases

Sexually Transmitted Diseases (STD) Trauma (Rape) Effects of Aging on the System DISORDERS RELATED TO LABOR AND DELIVERY Common Disorders of Pregnancy a. Abortion b. Ectopic Pregnancy c. Placenta Previa d. Abruptio Placenta e. Disseminated Intravascular Coagulation f. Pregnancy-Induced Hypertension

g. Chronic Medical Problems h. Hemolytic Diseases i. Multiple Pregnancy j. Substance Abuse k. Preterm Labor

PHYSIOLOGY OF NORMAL CHILDBIRTH Variables Affecting Labor

a. Stages of Labor b. Complications of Childbirth? i. Preterm Labor and Birth ii. Premature Rupture of Membranes iii. Dystocia iv. Abnormal Duration of Labor v. Prolapsed Cord c. Postpartum Care and Complications i. Care of Infant ii. Care of Mother iii. Newborn Physiological Changes

MATERNAL PHYSIOLOGIC CHANGES Postpartum Complications a. Trauma in Pregnancy b. Childhood Diseases and Disorders c. Infectious Diseases d. Respiratory Failure e. Digestive Diseases

CELLULAR INJURY

f. Fluid Imbalances g. Cardiovascular Diseases h. Musculoskeletal Diseases i. Hematologic Diseases j. Trauma i. Abuse

INFLAMMATION AND INFECTION

Cellular Adaptation Cell and Tissue Death Organism Death

a. Neoplasms b. Terminology Related to Neoplasms and Tumors c. Classification of Neoplasms d. Benign and Malignant Neoplasms e. Hyperplasias and Neoplasms f. Development of Malignant Neoplasms (Cancer) i. Invasion and Metastasis of Cancer. ii. Grading and Staging of Cancer. iii. Causes of Cancer 1) Chemical Carcinogens 2) Hormones 3) Radiation 4) Viruses 5) Genetic Predisposition 6) Personal Risk Behaviors

1. Defense Mechanisms 2. Inflammation

a. The Inflammatory Process b. Chronic Inflammation c. Inflammatory Exudates d. Inflammatory Lesions i. Abscesses ii. Ulcer iii. Cellulitis e. Tissue Repair and Healing f. Delayed Wound Healing

3. Infection

a. Frequency and Types of Infection

Signs and Symptoms of Cancer Cancer Treatment

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LIFELINE PREHOSPITAL EMERGENCY CARE

THE population of the Philippines is one of the fastest growing in the world. Now pegged at over 101 million, Filipinos have grown in number by more than 8 million in the past 5 years and by over 24 million in the past 16 years. With this growth comes a great demand for healthcare. This ballooning population means more women are getting pregnant, more babies are being born, more children are going to school, and more young people are entering the workforce. It also means that more elder Filipinos are requiring special care. In this chapter, you will study the development of the human body -- from childbirth, to toddler years, to adolescence, to adulthood, all the way to the senior years. As a future EMT, you will face cases involving any of this age groups and it is very important for you to understand the different challenges they will give you. Every stage of the human bodyâ&#x20AC;&#x2122;s lifespan and development is different. This is the reason why medical doctors have specializations. Pediatricians are specialist in kids. Obstetricians are specialists in pregnancy and childbirth. Geriatricians are specialists in treating old people. But you as a future EMT must be like a family emergency doctor, a jack-of-all-trades of sorts who must be familiar with the illnesses or injuries that people of all age would encounter. It is our hope that after going through this chapter, you would have a basic knowledge of the human bodyâ&#x20AC;&#x2122;s development and would be able to apply such knowledge in your future work as EMT.

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Understanding Our Bodyâ&#x20AC;&#x2122;s Development Infancy and Toddler Age Preschool to Adolescence Early Adulthood to Late Adulthood

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Birth to 28 days – newborn throughout human development with assessment and strategies for patients of all ages. 28 days to 1 year - infant

to 28 days – newborn

Day 5 1 FOUNDATION OF EMT PRACTICE UNIT INTRODUCTION FOUNDATION OF EMT PRACTICE

ys to 1 year - infant KEY TERMS

DAY 5

Infancy – Birth to one year.

UNDERSTANDING OUR BODY’S DEVELOPMENT

Definition – Neonate (newborn) is the term that KEY TERMS refers to a child from birth to one month of age. Infancy – Birth to 1 year

Birth to 28 daysDefinition– Consid- Neonate (Newborn) is ered as newborn the term referring to a child from birth to one month of age.

28 days to one year - Considered as infant. Birth to 28 days – newborn 28 days to 1 year - infant

Importante para sa isang EMT na pag-aralan ang pagbabago sa katawan ng tao mula sa pagiging sanggol, pagiging bata, dalaga o binata, hanggang sa tumanda. Sa pamamagitan ng pag-aaral sa bawat yugto sa buhay ng tao, maiintindihan ng isang EMT ang mga posibleng maging problema ng kanyang pasyente at kung papaano sosolusyunan ito.

“

LIFE SPAN AND DEVELOPMENT

LEARNING OBJECTIVES

 Familiarize the EMTs with the growing body of human development.  Integrate the physiological, psychological, and sociological changes throughout human development with assessment and communication strategies for patients of all ages.

INTRODUCTION

LEARNING INTRODUCTION Life span development looks at the physiological (physical) an OBJECTIVES (mental and psychosocial) changes that occur from birth to deat The human body goes through a myriad of changes as it goes through life. In this chapter, you will be taught about the physical andof Pediatric pediatric patient inimportant the Chapter psychological changes that occur from birth to death.

•more Familiarize the the about Em EMTs with the about the geriatric patient in the Chapter of "Geriatric Emergencie growing body of The stages of human development that we will human development. study here areat thethe following: looks physiological (physical) and psychosocial • Integrate theLife span development Inphysiological, this chapter, wepsychosocial) will follow Jamie as she develops through (mental and changes that occur from birth to death. You will learn the more about the pediatric patient in the Chapter of Pediatric Emergencies," and • Infancy psychological, and stages of life: about the geriatric patient in the Chapter of "Geriatric Emergencies." • Adolescence sociological changes Infancy • Toddler phase throughout human In this chapter, we will followadulthood Jamie as she develops through the following • Early developmentstages with of life: Adolescence • Preschool age assessment and  Infancy • Middle adulthood communication Toddler phase • School age Adolescence strategies for patients Toddler phase • Late adulthood of all ages. Early adulthood Early adulthood Preschool ageage Preschool adulthood MiddleMiddle adulthood School age SchoolLate ageadulthood

“        INFANCY (BIRTH TO 1 YEAR) Late adulthood

You only need to spend a short time with infants and you will be able to attest to the phenomenal changes that occur during the first year of life. This is the period referred to as Infancy. The infant is a small(BIRTH bundle ofTO joy,1totally INFANCY YEAR) dependent upon others, and grows to begin walking and develop a unique If personality. you have ever spent time around infants, you can attest to the phenomenal

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changes that occur during this first year of life. This is the period referred to as Infancy. The infant is a small bundle of joy, totally dependent upon others, and NOTE: Most of the information chapterwalking came fromand the 12th edition of theabook “Emergency Care” by grows intothis begin developing unique personality.

INFANCY (BIRTH TO 1 YEAR)

Daniel Limmer and Michael O’Keefe. Used with permission from the book’s publisher, Pearson Education, Inc.

If you have ever spent time around infants, you can attest to th

FOUNDATION OF EMT PRACTICE

communication DAY 5

INTRODUCTION

VITAL SIGNS

VITAL SIGNS At birth

 Respiratory rate is 40–60 breaths per minute.(after few minutes – RR is 30-40 breaths per minute

At Birth

 Tidal volume is 6–8 mL/kg. • Respiratory rate is 40–60 breaths  per Heart rate is 140-160 bpm. (first 30 mins – HR is 100– 60bpm) minute.(after few minutes – RR is  Average systolic blood pressure is 70 mmHg. 30-40 breaths per minute. • Tidal volume is 6–8 mL/kg. • Heart rate is 140-160 bpm. (first 30 mins – HR is 100– 60bpm). • Average systolic blood pressure is 70 mmHg.

By One Year Old

• Respiratory rate is 20–30 breaths per minute. • Tidal volume is 10–15 mL/kg. • Heart rate is about 120 beats per minute. • Average systolic blood pressure is 90 mmHg.

By one year of age

 Respiratory rate is 20–30 breaths per minute.  Tidalat volume is 10–15 mL/kg. span development looks the physiological (physical) and psychosocial ndLife psychosocial  Heart rate is about 120 beats per minute. th. (mental You will learn and psychosocial) changes thatblood occur from birth to death. You will learn  Average systolic pressure is 90 mmHg

PHYSIOLOGICAL CHANGES mergencies," and the pediatric more about patient in the Chapter of Pediatric Emergencies," and PHYSIOLOGICAL CHANGESImmune System es."aboutPhysical Structure patient in the Chapter the geriatric of "Geriatric Emergencies." i. The head accounts for 25 percent of the weight of a i. Most of a neonate’s immunity arises from antibodies Physical structure neonate. received through the placenta. i. The head accounts for 25 percent of the weight of a neonate. following ii. Weight drops during first two weeks but is regained. ii. Passive immunity is retained through the first six Jamie through ii. Weight Weight dropsas during twomonths weeks but then is regained. “ In this chapter, 3.0 – 3.5 kgwe (6.6 –will 7.7 lb) follow at birth. doubles by she six firstdevelops of life or as long asthe breastfollowing feeding continues. Childhood immunizations normally begin after birth. stages ofmonths life: and triples by 12 months. 3.0 – 3.5 kg (6.6 – 7.7 lb) atiii.birth iii. Infants require breastmilk or formula, followed by by 6 months; triples by 12 months Weight doubles soft foods and then solid foods once primary teeth Infancy Nervous System followed by soft foods and iii. Infants require breast milk or formula, appear. i. Infants have reflexes, or instantaneous and involuntary then solid foods teeth appear. iv. Their airway is narrow and easily obstructed. They once primary Adolescence movements, that result from a stimulus. iv. breathing. airway narrow; easily obstructed; Noseextremities and diaphragm used when for stimulated. use their nose and diaphragm for ii. Well-flexed move equally Toddler phase iii. Infants nervous system includes four reflexes that will breathing. Pulmonary System diminish over time: Early adulthood i. The airways of an infant are shorter, narrower, less Pulmonary system stable, and more easily obstructed than those of an • MORO REFLEX -- When you startle her, she throws Preschool age adult. her armsnarrower, out. spreads fingers, then grabs with i. The airways of an infant are shorter, lessher stable, andand more ii. Infants are primary nose breatherseasily until obstructed four weeks of her fingers and arms. These movements should be relathan those of an adult. Middle adulthood age. tively equal on both sides ii. Infants are primary nose breathers until four weeks of age. iii. The lung tissue of infants is fragile and prone to School iii. The lung tissue of infants is fragile and prone to trauma. trauma. age • PALMAR REFLEX -- When you place your finger in iv. Their accessory muscles are immature, and the chest her palm,and she the grasps it. Within a couple of months, this iv. The accessory muscles are immature, chest wall is rigid. Late wall isadulthood rigid.

       

heINFANCY phenomenal

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

(BIRTH TO 1 YEAR)

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Within a couple of months, this merges with she the  grasps Palmar it. reflex. When you place your finger in her palm, ability the hand, graspstoit.release Withinan a object couplefrom of months, this merges with the

 Rooting you from touchthe thehand, infants cheek when she ability to reflex. releaseWhen an object hungry, she turns her head the the sideinfants touched.  is Rooting reflex. When you touch cheek when she  Sucking reflex. When you stroke Jamie's lips, she starts suckis hungry, she turns her head the side touched. This reflex. reflex works conjunction with the reflex.  ing. Sucking Wheninyou stroke Jamie's lips,rooting she starts suck-

UNDERSTANDING THE BODY’S DEVELOPMENT

ing. This reflex works in conjunction with Day 5 the rooting reflex.

MORO REFLEX MORO MOROREFLEX REFLEX

PALMAR REFLEX PALMAR REFLEX PALMAR REFLEX

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

UNIT 1 UNIT DAY 1 5 DAY 5

Our bones at the top of our skull are not fused at birth. The “soft spot” where these bones meet are called a fontanelle. The posterior fontanelle usually closes in 2 or 3 months, and the anterior one closes at 18 months. Looking at the anterior fontanelle. you can get a good idea of an infant’s state of hydration. Normally, the fontanelle is level with, or slightly below, the surface of the skull. If the fontanelle is sunken, this indicates dehydration. If the fontanelle is bulging, you should suspect increased pressure inside “ the skull.

merges with the ability to release an object from the PSYCHOSOCIAL CHANGES hand, • ROOTING When you touch the infant’s LIFEREFLEX SPAN--AND DEVELOPMENT Most infants will protest when separated from LIFE AND DEVELOPMENT cheek when sheSPAN is hungry, she turns her head the side their caregivers. If an infant does not seem upset touched. when separated from a parent, you as an EMT should FOUNDATION OF • SUCKING REFLEX -- When youEMT strokePRACTICE Jamie’s lips, consider underlying causes. FOUNDATION OF EMT PRACTICE she starts sucking. This reflex works in conjunction with the rooting reflex. Infants communicate all of their needs by crying. Some crying can be avoided if the parent is allowed ROOTING REFLEX ROOTING REFLEX to hold the infant during assessment. By the end ROOTING REFLEX of infancy, a favorite toy may calm a child during assessment, as long as the toy does not cause an airway obstruction. A calm voice during assessment will help calm both the child and the parents.

SUCKING REFLEX SUCKING REFLEX REFLEX SUCKING

132

Initially, they will sleep from 16 to 18 hours in total throughout the day and night. This will soon change to about 4 to 6 hours during the day and 9 to 10 hours during the night. Although each infant varies, usually in 2 to 4 months the infant will sleep through the night. Even though infants sleep a lot, they are easily awakened.

Initially, they will sleep from 16 to I8 hours in total throughout the day and night. This willthey soonwill change to about 6 hours during the day and 9 toand 10 night. hours Initially, sleep from 16 to4I8tohours in total throughout the day during night. Although each4infant varies, during usually the in 2day to 4and months This willthe soon change to about to 6 hours 9 to the 10 infant hours will sleep the night.each Eveninfant though infants do sleep lot, they are to during thethrough night. Although varies, usually in 2 toa 4 months theeasy infant awaken. will sleep through the night. Even though infants do sleep a lot, they are easy to LIFELINE PREHOSPITAL EMERGENCY CARE awaken. The bones at the top of the skull are not fused at birth. The "soft spot" where thesebones bonesatmeet are called fontanelle. posterior fontanelle closes The the top of theaskull are notThe fused at birth. The "softusually spot" where in 2 orbones 3 months, anterior one closes and IK months. Looking these meetand are the called a fontanelle. Thebetween posteriory fontanelle usually closes at 2 the fontanelle. you can one get a goodbetween idea of infant's of hydration. in or anterior 3 months, and the anterior closes y and IKstate months. Looking Normally, the fontanelle is level with, or slightly below the surface of the skull. If at the anterior fontanelle. you can get a good idea of infant's state of hydration. the fontanelle is sunken, isthis indicates If the is bulging, Normally, the fontanelle level with, ordehydration. slightly below the fontanelle surface of the skull. If

By 2 months the baby can track objects and focus on objects 8 to 12 inches away. She can recognize familiar faces, display primary emotions, hear and recognize some familiar sounds and voices and can move in response to stimuli. By 6 months, the baby can sit upright in a high chair and make one-syllable sounds, is able to raise upper body and grasp and shake hand toys. She is also able to following moving objects, recognize familiar objects at a distance, and try to imitate familiar sounds.

³ ⁴

By 2 months the baby can Track objects and Focus on objects 8 to 12 inches away. He/ She can Recognize familiar faces, Display primary emotions, Hear and recognize some familiar sounds and voices and can Move in response to stimuli. By 6 months, he/she can Sit upright in a high chair and Make one-syllable sounds. Is able to Raise upper body and Grasp and shake hand toys. He/she is Following moving objects, Recognize familiar objects at a distance and Try to imitate familiar sounds.

TODDLER PHASE – 12 –TO12 36 MONTHS TODDLER PHASE TO 36 MONTHS

Skeletal system

UNIT 1 DAY 5

i. Fontanelle are soft spots on the skull that allow the head to compress in the birth canal during delivery and to allow for the growth of the brain during infancy. FOUNDATION OFbutEMT Ii. Fontanelle should not be pressed will bePRACTICE depressed if child is dehydrated. FOUNDATION OF soEMT PRACTICE iii. Bones grow throughout infancy, the EMT should know what activities are normally present at various stages of infancy. iv. Fontanelle not fused at birth – still soft until 9 to 18 months.

SIDE VIEW

VITAL SIGNS VITAL SIGNS

and respiratory tend to decrease as aages. child Heart andHeart respiratory rates tendrates to decrease as a child ages.  HR – 80 to 130 beats per minute • Heart Rate (HR) – 80 to 130 beats per minute  RR – 20•to 30 breaths per minute Respiratory Rate (RR) – 20 to 30 breaths per minute Systolic blood pressure increases as a child ages. Systolic blood pressure increases as a child ages.  BP – 70•to 100 Pressure mmHg – 72 to 104 systolic; 37 to 56 Blood diastolic.

PHYSIOLOGICAL CHANGES Physical structure

CHANGES system continue to grow.  The PHYSIOLOGICAL bones of the musculoskeletal  Children have their primary teeth by the end of this period. Physical structure but weight gain slows down.  Muscle mass increases,

• The bones of the musculoskeletal system continue to grow. Pulmonary systemhave their primary teeth by the end of this • Children  Terminal airways period. continue to branch. • Muscle increases, but weight gain slows down.  Alveoli continuemass to grow in number.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

TOP VIEW TOP VIEW

Pulmonary system

• Terminal airways continue to branch. “ • Alveoli continue to grow in“ number.

Immune system

• Passive immunity from mother is lost. • Active immunity to common pathogens develops.

Nervous system

• The brain is the fastest growing part of the body. • Fine motor skills begin to develop. • It is important for the EMT to recognize what activities toddlers and preschoolers are capable of performing.

LIFELINE

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA ² Limmer (Brady)

³ Pollack, (AAOS) ⁴ NHTSA

PREHOSPITAL EMERGENCY CARE

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PSYCHOSOCIAL CHANGES

Language takes the place of crying as the sole form of communica anxiety begins atTHE approximately 18 months of age. By age BODY’S DEVELOPMENT Day 5 tionUNDERSTANDING schooler can say his name and address, recall stories, and tell sto can play simple games and follow basic rules. Children begin to de ships outside the immediate family. “The EMT should communic PSYCHOSOCIAL CHANGES child on a level he understands by choosing phrases carefully and Language takes the place of crying as theing sole equipment. form of communication. Separation anxiety begins at

approximately 18 months of age. By age five, a preschooler can say his name and address, recall stories, and tell stories. Children can play simple games and follow basic rules. Children begin to develop thecommunicate toddler phase, physical, mental, friendships outside the immediate family. TheDuring EMT should with the child on a level he understands by choosing phrases carefully and demonstrating Body systemsequipment. continue to grow and refine

and social developme themselves, and the t ops more individuality This age group's curiosity has led to such During the toddler phase, physical, mental, and social development continue. Body systems terms asdevelops curtain climbers or rug raw. Their continue to grow and refine themselves, and the toddler more individuality This age group has developing personality a phenomenal sense of curiosity that they tend to do a lot of climbing and exploring. Their developing referred to as the "terrible twos." Like all phases of childhood, the personality is sometimes referred to as the “terrible twos.” Like all phases of childhood, these years can be be a very rewarding time for both toddler and caregivers. a very rewarding time for both toddler and caregivers.

PRESCHOOL AGE – 3 TO 5 YEARS

PRESCHOOL AGE – 3 TO 5 YEARS OLD Preschool age is a time of exciting physiological and psychosocial development. This is often a time when preschoolers are put into social interaction situations such as daycare or preschool.

“

VITAL SIGNS

a. Heart Rate – 80 to 120 beats per minute b. Respiratory Rate – 20 to 30 breaths per minute c. Systolic Blood Pressure – 80 to 110 mmHg

PHYSIOLOGICAL CHARACTERISTICS – Their body systems continue to develop.

PSYCHOSOCIAL CHARACTERISTICS – They are eveloping inter-

active and social skills, attend a preschool where they are involved with peer groups. Peer groups provide a source of information about other families and the outside world. Interaction with peers offers opportunities for learning skills, comparing themselves to others, and feeling part of a group.

PRESCHOOLER By Age Three

By Age Five

Preschool age is a.aHop, time of swing, continued a. Walk alone jump, climb andphysiological do b. Handle several toys when walking ment. This is oftensummersaults a time when preschoolers arc c. Climb up and down furniture or stairs Dress and undress without assistance situations such asb. day care or preschool. d. Scribble and play with toys c. Use forks, spoons, and sometimes knives e. Find hidden objects appropriately f. Sort objects by shape or color d. Count ten or more objects, Trace and draw pictures

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² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

and psychoso put into socia

By age Five

a. Hop, jump, swing, climb and do summersaults ation. Separa-b. Dress and undress without assistance e five, a pre-c. Use forks, spoons, and sometimes knives appropriately ories. Children d. Count ten or more objects, Trace and draw pictures

UNIT 1 DAY 5

evelop friendcate with the SCHOOL AGE – 6 TO 12 YEARS d demonstrat-

SCHOOL AGE – 6 TO 12 YEARS OLD Whether attending a public or private school, or being home-schooled, the stage of development referred to as schoolattending age opens vast for the child. Whether a opportunities public or private school,

ent continues. toddler develh affectionate is sometimes ese years can

or being home-schooled, the stage of development referred to as school age opens vast PHYSIOLOGICAL CHANGES opportunities for is the child. • Body temperature approximately 98.6°F (37X) • Gains 3 kg (6.6 lb) • grow 6 cm (2.4 in.) per year (Figure 7-5). Skeletal VITAL changesSIGNS • Bones increase in density and grow in size. • Primary teeth are replaced with permanent teeth. Nervous System - Brain function increases. a. Normal heart rates range from 70–110

beats per minute. PSYCHOSOCIAL CHANGES

SCHOOL AGE

b. Respiratory rates range from • Some children struggle with nocturnal enuresis20–30 or bedwetting. breaths per minute. • They develop relationships outside the home. c. Systolic blood pressure • They participate in social activitiesis between 80– • They 120 are capable of fundamental reasoning and mmHg. problem solving. • They develop their own self-concept, self-esteem, and morals. • They now understand pain, illness, death, and loss. • They normally identify EMTs, firefighters, and law enforcement officers as people who help.

FOUNDATION O PHYSIOLOGICAL CHANGES

 body VITAL SIGNStemperature is approximately

 3 kgheart (6.6 lb) a. gain Normal  grow 6 cm (2.4 rates range fromin.) per year (Figur 70–110 beats per Skeletal changes minute.  Bones increase in density and grow b. Respiratory  Primary teeth are replaced with pe rates range from Nervous - Brain function inc 20–30System breaths per minute. PSYCHOSOCIAL CHANGES c. Systolic blood  Some children struggle with noctu pressure is between relationships 80–120  Develop outside the h mmHg. in social activities  Participate  Capable of fundamental reasoning  Develop a self-concept, self-esteem  Understand pain, illness, death, an  Identify EMTs, firefighters, and la who helps

ADOLESCENCE – 13 TO 18 YEAR

VITAL SIGN

 Norma

beats p

 Respira

breaths

 Systolic

² Limmer (Brady)

³ Pollack, (AAOS) ⁴ NHTSA

120 mm

ADOLESCENCE – 13 TO 18 YEARS OLD

VITAL SIGNS

 Genera

“

• Normal heart rates range from 55–105 beats per minute. • Respiratory rates range from 12–20 breaths per minute. • Systolic blood pressure is between 100– 120 mmHg.

PHYSIOLOGICAL CHANGES

• Generally experience growth spurt beginning with enlarged feet and hands, followed by extremities, followed by chest and trunk • Adolescents go through puberty, during which sexual develop- organs mature.

ocial al interaction

PSYCHOSOCIAL CHANGES

PHYSIOLOG

• Experience changes that cause family conflicts, mostly revolving around the adolescent and his parents. • They become more argumentative and aware of the shortcomings of others. • They may participate in risky or self-destrutive

ning w lowed and tru  Adolesc which s

behaviors. • They want to be treated as adults, but parents’ consent is required ADOLESCENT for medical treatment PSYCHOSO • They want privacy and may disclose more information when  Experie parents are absent. conflict • They are searching for or developing adolesc their personal identity.  Become • Their self-consciousness and of the s concern about body image  May pa increase. behavio • Some may exhibit anti-social  Want to behavior around eighth or ninth grade. sent is r • They have increased interest in opposite sex and may participate in unprotected sexual activity.

² Limmer (Brady)

LIFELINE ³ Pollack, (AAOS)PREHOSPITAL EMERGENCY CARE ⁴ NHTSA

135



Day 5

UNIT 1 Want privacy and may disclose more information DAYwhen 5 parents are absent

 Develop their identity  Increase self-consciousness and concern about body image UNDERSTANDING THEinBODY’S DEVELOPMENT  Antisocial behavior peaking around eighth or ninth grade  Increased interest in opposite sex and may participate in un-

EARLY ADULTHOOD – 19 TO 40 YEARS OLD

protected sexual activity

PHYSIOLOGICAL CHANGES

EARLY ADULTHOOD – 19 TO 40 YEARS

VITAL SIGNS

• Peak physical condition occurs between 19 and 26 years of age. • After peaking, physical condition begins to slow down. • Adults gain weight, store fat, and experience decreased muscle tone. • Adults’ spinal disks begin to settle. • Adults develop lifelong habits during this period.

HEART RATE = Average 70/ VITAL SIGNS minute

RESPIRATORY RATE = 16-20/ HEART RATE = Average 70/minute

minute RATE = 16-20/minute RESPIRATORY BLOOD PRESSURE = 120/80 = 120/80mmHg

BLOOD PRESSURE mmHg

With great pomp and circumstance, the adolescent With greatgraduates pomp andfrom childhood to adulthood. Somethesay the best years are circumstance, adolescent behind; some the best graduates fromsay childhood to years are ahead. But life is what you make adulthood. Some say the best of it. and early adulthood opens years are behind; someup saygreat the opportunities. best years are ahead. But life

PSYCHOSOCIAL CHANGES

• They take on more responsibilities. • They leave their parents’ home. • They develop romantic relationships, some of which lead to marriage. • Childbirth is common in this age group. • They are now more capable of dealing with stress than when they were younger. • Accidents,–particularly road crashes, are a leading of ADULTHOOD 41 TO 60 YEARS death in this age group.

FOUNDATION OF EMT PRACTICE

DDLE

YOUNG ADULT

is what you make of it. and early adulthood opens up great opportunities.

PHYSIOLOGICAL CHANGES

most, middle adulthood is a time of reflecting on how far they have come where they want to go. This internal conflict is often called "midlife crisis."



Peak physical condition occurs between 19 and 26 years of age.  After peak physical condition, physical condition begins to slow down. PHYSIOLOGICAL CHANGES  Adults gain weight, store fat, and experience decreased musLa “ cle tone. During this stage of development, they has m health issues. For people,changes middle adulthood is afrom her no most significant in vital signs  Adults’ spinal disks begin to settle. du • May be burdened by time of reflecting on how far they have come Early adulthood. She is starting to have• Adults more lifelong habits during this period.  become Adults develop financial commitments. and where they want to go. This internal some vision problems and is now wearing susceptible to chronic illness conflict is often called “midlife prescription glasses. Her crisis.” cholesterol is a little and disease. PSYCHOSOCIAL CHANGES • May experience high, and she is concerned about health • Cardiovascular health  Take on more problems. Cancer develops in this age becomes a concern. responsibility empty-nest syndrome becoming more task  Leave home group, weight control become more and for• Cardiac outputparents’ decreases. During this stage of development, they oriented sees lead the to marwomen in the late 40s to early 50s. meno-• Cholesterol levels increase.  Develop romantic relationships, some as of she which have no significant changes in vital signs from time for accomplishing pause commences. Heart disease is the ma-• Weight isriage gained. her early adulthood. They are starting to have her lifetime goals jor killer after the age of 40 in all age. sex.• Vision mayisrequire  changes Childbirth common. some vision problems and are now wearing diminish. and racial groups. corrective lenses.  More capable of dealing with stress than when younger prescription glasses. Their cholesterol is a little • Hearing may decrease. high, and they are concerned about health  Accidents are a leading of death in this group. With her age children

MIDDLE ADULTHOOD – 41 TO 60 YEARS OLD PHYSIOLOGICAL CHANGES

PHYSIOLOGICAL CHANGES

• Women go through VITAL SIGNS problems. Cancer develops in this age group, menopause, which is the end weight becomes moreis a70 problem,  control Average heart rate beats per minute of menstruation and fertility. and for women in the late 40s to early 50s,  Average respiratory rate is 16–20 breaths “ menopause commences. Heart disease is the per minute. major killer after the age of 40 in all age, sex. PSYCHOSOCIAL CHANGES  Average and racial groups.blood pressure is 120/80 mmHg. • May perceive problems as challenges rather than threats. VITAL SIGNS • May help younger generations. • Average heart rate is 70 beats per • May question their own minute. YSIOLOGICAL CHANGES accomplishments. (Brady) • Average respiratory rate is 16–20 breaths³² Limmer Pollack, (AAOS) Adults become more susceptible to chronic illness and disease. ⁴ NHTSA • May set new goals for the per minute. Cardiovascular health becomes a concern. remainder of their lives. • Average blood pressure is 120/80 • May delay seeking help for Cardiac output decreases. mmHg. Cholesterol levels increase. 136 LIFELINE PREHOSPITAL EMERGENCY CARE Weight is gained. Vision changes may require corrective lenses. Hearing may decrease. Women go through menopause, which is the end of menstruation and

starting lives of their own, this may be a time of increased freedom and opportunity for self fulfilment. She may be concerned about her children as they start their new lives, and she is also concerned about caring for aging parents.

FOUNDATION OF EMT PRACTICE

ATE ADULTHOOD –LATE 61 YEARS AND OLDER ADULTHOOD – 61

YEARS AND OLDER Late adulthood is often referred to as the “twilight years.”This stage of development brings about several physiological changes, second only to those seen during infancy or adolescence.

PHYSIOLOGICAL CHANGES

• The maximum life span is 120 years for a human being. • Life expectancy is the average years of life remaining based on an individual’s year of birth. ELDERLY • Cardiovascular system becomes less efficient, putting more strain on the body. • Blood vessels thicken. • Functional blood volume is decreased. VITAL SIGNS • Respiratory system is weakened. signs will depend on physical and ate adulthoodVital is often referred to the as patient’s the "twilight years."This stage of develop• Chest wall and bone structure weaken, health condition. The elderly’s cardiovascular system ent bringsbecomes aboutless several second onlyelasticity to those of theseen diaphragm is diminished. efficient,physiological and the volume ofchanges, blood decreases. uring infancy or adolescence. She is less tolerant of tachycardia (fast heart rate). Her • Diffusion of gases through the alveoli is respiratory system deteriorates and makes her more diminished. likely to develop respiratory disorders. Changes in the • Nervous system undergoes changes. endocrine system result in decreased metabolism. Her • Brain gets smaller and neurons are lost. sleep-wake cycle also is disrupted, causing her to have • Sleep cycle may be disrupted. systemsand are deteriorating Vital signssleep willproblems. dependAll onother herbody physical health condition. •Her cardiovascuReaction time to stimuli is increased. as time progresses. lar system becomes less efficient, and the volume of blood decreases. She isdulled. • Senses may become • Heart rate, respiratory rate, and blood pressure Endocrine,deterioreproductive, and renal on physical(fast and health status. less tolerant ofdepend tachycardia heart rate). Her respiratory• system • Underlying diseases, poor physical conditioning, and sytems are affected. rates and makes her more likely tosigns. develop respiratory disorders. Changes in medications can alter vital • Metabolism and insulin production the endocrine system result in decreased metabolism. Her sleep-wake cycle decrease. PSYCHOSOCIAL CHANGES • Reproductive organs atrophy. also is disrupted, causing her to have sleep problems. All other body systems • Wisdom is attributed to age in some cultures. • Elimination of urine decreases. are deteriorating time • Someas adults in progresses. this stage are cared for by family. • Permanent teeth are often lost. Some adults in this stage are isolated and alone.  Heart•• rate, respiratory rate, and BP depend on physical and health • EMTs must be aware of underlying health Leaving a long-established home is often required. conditions in addition to any emergency status.• Difficult decisions often center on financial burdens and requirements. situation.  Underlying diseases, physical • Independence mustpoor often be given up. conditioning, and medications can • Thesigns. loss of loved ones and friends must be alter vital acknowledged.

VITAL SIGNS

SYCHOSOCIAL CHANGES  Wisdom is attributed to age in some cultures.  Some adults in this stage are cared for by family.  Some adults in this stage are isolated and alone.

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EVERY day in Metro Manila, there is an average of 66 people who figure in motorcycle accidents. One third of this number ends up dead, while two thirds get treated in hospitals. In a motorcycle accident, the victim usually sustains injuries in the head, neck and the spinal cord. If they are lifted incorrectly, their condition could turn from bad to worse. It is, therefore, very important for you as a future EMT to learn the proper technique in carrying and lifting patients -- for their own sake and also for yours. A wrong move can aggravate the injury of a crash victim. A wrong move can also result in you incurring a back injury. These are the reasons why this chapter is

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very important. Today you will learn the basic techniques of carrying and lifting patients. You will learn the fundamentals of body mechanics or how the body moves. You will also be shown the equipment that you would use in carrying patients and how they work. Part of the lectures for this day is how to deal with children, especially those between 12 to 36 months in age. And most important of all, you would learn the fundamental principles of moving patients by knowing what conditions are urgent and what conditions are not. It is our hope that after this day you will be equipped with the important skills to be able to perform your job well as a life saver.

DAY

Techniques in Lifting and Carrying Patients Body Mechanics Patient-Carrying Devices Principles of Moving Patients Patient Positioning

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long problems. With the proper techniques, however, you ca patients safely. Proper lifting and moving must be practiced on e

BODY MECHANICS FOUNDATION OF EMT PRACTICE

Day 6

CRITICAL CONCEPTS Moving and positioning the patient requires special care to avoid injury to the team and the patient.

Oras ang pinakamalaking kalaban ng isang EMT. Kailangan ang mabilis na kilos dahil buhay ng pasyente mo ang nakataya dito. Kaya naman napakahalaga para sa isang EMT ang tamang paghahanda at pag-aaral kung papaano bubuhatin ang mga kagamitan, kung papaano ililipat ng puwesto ang pasyente at kung papaano gagawin ang lahat ng ito nang ligtas ang lahat. Sa chapter na ito ay pagaaralan natin ang mga paraan ng ligtas at mabilis na pagbuhat. Importante na matuunan at praktisin ang mga paraan na ito upang magamit sa oras ng responde.

TECHNIQUES IN LIFTING AND CARRYING PATIENTS

Body Mechanics refers (o the proper use of your body to preve facilitate lifting and moving.

LEARNING OBJECTIVES • Define the body mechanics. • Describe the safe moving of the carrying devices found in the ambulance. • Describe the guidelines and safety precautions for carrying. • Discuss the guidelines and safety precautions that should be followed when lifting a patient. • Discuss one-handed carrying techniques. • Discuss the universal considerations of moving patients.

“ “

INTRODUCTION

² Limmer, O’Keefe, “Emergency Care”, 12th Edition. Brady, NJ (2012) ³ Pollack, “Emergency Care and Transport of Sick and Injured”, 10th Edition. AAOS, MS (2011) ⁴ National Highway andspeed Traffic Safety (NHTSA), “EMT Basic Standard Department of T In an emergency, is oneAdministration of the most important element that youCurriculum“, must

have. In dangerous scenes, for example, you must rapidly move the patient to a safe place. When the patient has a life-threatening medical problem or a serious injury, getting him to a hospital quickly can mean the difference between life and death. Doing things fast, however, can mean committing a lot of mistakes. You can be so focused on the need to be fast as you lift and carry the patient that you make careless moves, These mistakes can injure your patient. And they can also injure you.

Back injuries are serious and have the potential to end your career as an EMT and cause lifelong problems. With proper technique, however, you can lift and move patients safely. Proper lifting and moving must be practiced on every call.

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an lift and move every call.

 What What areare your your physical physical characteristics? characteristics?  DoDo you you (or(or your your partner) partner) have have any any physical physical limitations limitations that that would would

make make lifting lifting difficult? difficult? 3. Communication. 3. Communication.  Make Make a plan. a plan. Then Then communicate communicate thethe plan plan forfor lifting lifting and and carrying carrying to to your your partner. partner. Follow these rules to prevent injury: ent injury and lo  Continue Continue to to communicate communicate throughout throughout thethe process process to to make make thethe 1. Position your feet properly. They should be on aWhen move move comfortable comfortable for for the the patient patient and and safe safe for for the the EMTs EMTs When it it Body Mechanics refer to the proper use of your body firm, level surface and positioned shoulder-width to prevent injury and to facilitate lifting and moving. comes comes time time to to dodo thethe lifting, lifting, apart.

BODY MECHANICS

2. Use your legs. Do not use your back to do the Consider theFollow following before lifting anyto Follow these these rules rules to prevent prevent injury: injury: lifting. patient: 1. 1. Position Position your your feet feet properly. properly. They They should should beAttempts be onon a to firm, a make firm, level surface surface 3. Never turn or twist. anylevel other 1. The Object. moves while you are lifting are a major cause of and positioned positioned shoulder-width shoulder-width apart. apart. • What is the weight of theand object? injury. • Will you require additional help inyour lifting? 2. 2. Use Use your legs. legs. DoDo notnot useuse your your back back lo do lo do thethe lifting. lifting.

3. 3. Never Never turn turn or or twist. twist. Attempts Attempts to make make any any other other moves moves while while you you arcarc 4. Dotonot compensate when lifting with one 2. Your Limitations. Althoughlifting it may not always be lifting are are a major a major cause cause of of injury. injury. hand. Avoid leaning to either side. Keep your back possible to arrange. EMTs of similar strength and

straight and locked. 4. 4. DoDo not not compensate compensate when when lifting lifting with with one one hand. hand. Avoid Avoid leaning leaning to to height can lift and carry together more easily. • What are your physical characteristics? cither cither side. side. Keep Keep your your tack tack straight straight and and locked. locked. • Do you (or your partner) have any physical limita5.your Keep thebody, weight close toclose your body, or as This 5. 5. Keep Keep thethe weight weight close close to to your body, or or as as close as as possible. possible. This al- altions that would make lifting difficult? This allows you to use your legs close as possible. lows lows you you to to useuse your your legs legs rather rather than than your your back back while while lifting. lifting. The far-farrather than your back while lifting. The farther theThe ther ther the the weight weight is from is from your your body, body, the the greater greater your your chance chance of of injury. injury. Communication. weight is from your body, the greater your chance • Make a plan. Then6. communicate the plan for liftof injury. 6. Use Use a stair a stair chair chair when when carrying carrying a patient a patient onon stairs stairs whenever whenever possible. possible. ing and carrying to your partner. Keep Keep your your back back straight. straight. Rex knees knees and and lean lean forward thethe • Continue to communicate throughout the process 6. Rex Useyour ayour stair chair when carrying aforward patientfrom onfrom hips, hips, not not the the waist. waist. If you If you are are walking walking backward backward down down stairs, stairs, ask a a to make the move comfortable for the patient and stairs whenever possible. Keep your back straight. ask safe for the EMTs When helper it comes time to do the helper to to steady steady your your back. back.Flex your knees and lean forward from the hips, not lifting, the waist. If you are walking backward going down the stairs, ask a helper to steady your back.

Transportation, USA, (2005)

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Day 6

KEY TERMS A patient-carrying device is a stretcher or other device designed to carry the patient safely to the ambulance and/ or to the hospital.

Ang mga kagamitang pambuhat ng pasyente, gaya ng stretchers, ay napakahalaga sa EMTs. Ang maling paggamit dito ay maaaaring magresulta sa dagdag na disgrasya sa pasyente. Halimbawa, ang stretcher na hindi naka-lock ay maaaring bumigay, at ang stretcher na hindi binabantayan ay maaaring gumulong palayo sa grupo. Sakaling may madisgrasya dahil sa mga kapabayaan na ito, maaaaring mademanda ang grupo. Kaya importante na malaman mo kung papaano ang tamang paggamit sa mga stretchers upang mas maging epektibo ka bilang EMT.

LIFTING AND CARRYING PATIENTS

PATIENT-CARRYING DEVICES

UNIT 1 DAYstretchers, 6 There are many kinds of patient-carrying devices, including

UNIT DAY

FOUNDATIO

backboards and stair chairs. (Specifics arc offered later in this chapter.) When possible, it is almost always safer, as well as more efficient, to move patients over distances on a wheeled device such as a wheeled stretcher or a stair chair. These devices allow the patient to be rolled along instead of carried. Patient-carrying devices are mechanical devices, and all EMTs must be familiar with how to use them. Errors in the use of these devices may result in injuries lo the patient and to you. For example, a stretcher that is not locked in position may collapse, and untended stretchers may simply roll away. Such incidents may be cause for a lawsuit if the patient is injured as a result of improper practices or faulty equipment, The devices must be regularly maintained and inspected. You should know the rating of each piece of equipment (how much weight it will hold safely). Have alternatives available if the patient is too heavy or too large for any device. When lifting a patient-carrying device, it is best to use an even number of people. For a stretcher or backboard, one EMT lifts from the end near the patient’s head, the other from the feet, If there are four rescuers available, one person can take each corner of a stretcher or board. If there are only three people available, however, never allow the third person to assist by lifting one side. This can cause the device to be thrown off balance, resulting in the stretcher tipping over and injuring the patient.

Wheeled Stretcher This device—commonly referred to simply as the stretcher, cot, or litter —is in the back of all ambulances. There are many brands and types of wheeled stretcher, but their purpose is the same: to safely transport a patient from one place to another, usually in a reclining position. The head of the stretcher can he elevated, which will be beneficial for some patients, including cardiac patients, who have no suspected neck or spinal injuries. “

Depending on the model, the stretcher will have variable levels. When moving the patient, the safest level is closest to the ground. Wheeling the stretcher in the “ elevated position raises the center of gravity, making it easier for the stretcher to tip over. The stretcher is ideal for level surfaces. Rough terrain and uneven surfaces may cause the stretcher to tip. Make sure to use proper body mechanics while placing the stretcher into or taking it out of the ambulance. Proper body mechanics are also important while wheeling the stretcher from place to place. Remember, as discussed earlier in the chapter, odd numbers of EMTs may cause the stretcher to become off-balance. When the stretcher is lifted, two EMTs should lift at opposite ends of the stretcher—head and fool. “

There are two types of stretchers: manual stretchers and power stretchers. Manual stretchers are lifted by EMTs. These include the “self-loading stretcher” and the standard stretcher. A power stretcher will lift a patient from the ground level to the loading position or lower a patient from the raised position. These stretchers use a battery-powered hydraulic system that manufacturers state will lift patients on 20 consecutive runs and will lift patients up to 700 pounds.

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U D

1 6

FOUNDATION OF EMT PRACTICE

Other Types of Stretchers

ON OF EMT PRACTICE

The portable stretcher, or folding stretcher, may be beneficial in multiple-casualty incidents or incidents with many patients. These stretchers may be canvas, aluminum, or heavy plastic and usually fold or collapse. The scoop stretcher, or orthopedic stretcher, splits into two pieces vertically, allowing the patient to be “scooped” by pushing the halves together under him. The scoop stretcher does not offer any support directly under the spine, so it is for patients FOUNDATIONnot OFrecommended EMT PRACTICE with suspected spinal injury.

SCOOP STRETCHER

UNIT 1 DAY 6

stretchers UNIT 1 will undoubtedly help to prevent back injuries, OF EMT itDAY is vital6to follow theFOUNDATION manufacturer’s guidelines for use, properly maintain the stretcher, and use safe techniques as discussed in this chapter any time a patient is on your stretcher.

PRACTIC

BARIATIC STRETCHER

A basket stretcher, or Stokes stretcher, can be used to move a patient from one level to another or over rough terrain. The basket should be lined with a blanket before positioning the patient.

BASKET STRETCHER

A flexible stretcher, or Reeves stretcher, is made of canvas or some other rubberized or flexible material, often with wooden slats sewn into pockets and three carrying handles on each side. Because of its flexibility, it can be useful in restricted areas or narrow hallways. “ Although these power

FLEXIBLE STRETCHER

Many services use bariatric stretchers. These are stretchers that are constructed to transport obese patients—some rated for 800 pounds or more. There are ambulances that are specially equipped for the loading and transport of the bariatric patient. These ambulances have oversized equipment for patient assessment and care as well as ramps or hydraulic lifts to raise the loaded stretcher into the ambulance. Some are being equipped with hydraulic lifts to transfer obese patients onto the hospital cot. A stretcher can be carried by four EMTs. one at each corner. This method can be useful on rough terrain because it helps keep the wheels from touching the ground and provides greater stability. It is also beneficial when carrying a patient a long distance because it divides the weight among four EMTs instead of two. The patient will stay on the stretcher during transport to the hospital. Make sure that the stretcher is always used in accordance with manufacturer’s recommendations. Secure the patient to the stretcher before lifting or moving. After placing the patient into the ambulance, secure the stretcher to the ambulance. Ambulances have installed hardware for keeping the stretcher secured while the ambulance is moving. Failure to secure the stretcher properly will allow it to shift during transit, causing an unsafe condition for the EMTs as well as the patient.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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mobilized. These devices are available in traditional wood as well as in plastic versions Spine that resist splintering. (Splintered boards absorb body fluids, which may Boards harbour infection).

Day 6

There are two types of spine boards, or backboards: short and long. They are used for patients who are found lying down or standing and who must be immobilized. These devices are available in traditional wood as well as in plastic versions that resist splintering. (Splintered boards absorb body fluids, which may harbour infection).

LIFTING AND CARRYING PATIENTS UNIT 1 DAY 6

Stair Chair

FOUNDATION OF EMT PRACTICE

The stair chair has many benefits for moving patients from the scene to the stretcher. The first benefit, as the Spine Boards name implies, is that it is excellent for use on stairs. Large Shortand spine boardsThere are are used forboards, re- or backboards: short and long. They are stretchers often cannot be carried around tight corners twoprimarily types of spine used vehicles for patients when who are afound lying down or standing and who must be imup or down narrow staircases. The stair chair transports moving patients from neck TheseAdevices arespine available in traditional wood as well as in plastic the patient in a sitting position, which greatly reduces or spine injury is mobilized. suspected. short versions that resist splintering. (Splintered boards absorb body fluids, which may Short spine boards infection). are primarilyback for rethe length of patient and device, allowing the EMTboard to can slide between theused patient's harbour from vehicles whenshort a neck maneuver around corners and through narrow spaces. and Itseatmoving back. patients Once secured to the or spine injury suspected. A of short spine Thereisare types spine boards, or backboards: rolled board UNIT 1 also has a set of wheels that allow the device to be spine and wearing atwo rigid cervical colboard can slide between the patient's back FOUNDATION OF EMT PRACTICE short and long. They are used for patients who are found on patient lar, the can be moved from a sitting DAY 6 like a wheelchair over flat surfaces, lessening the strain and seat back. Once secured to the short lying down or standing and who must the EMT. position spine in theboard vehicle a supine position oncol- be immobilized. andtowearing a rigid cervical These devices are available in traditional wood as well as in a long spine board, Often, a vest-type extricalar, the patient can be moved from a sitting plastic versions resist splintering. Another type of stair chair has come into widetion use device in position in thein vehicle tothat a supine position on (Splintered boards is used place of a short spine Stair Chair body Often, fluids, awhich mayextricaharbour infection). spine board, vest-type EMS. This chair has wheels to roll the patient along a floor a long absorb board. tion device is used in place of a short spine or level ground but also has a track like system that allows The stair chair has many benefits for moving patients from the scene to the stretcher. Thegently first benefit, thepatient name implies, it is excellent for use on EMTs to slide as the downisathat staircase instead ofboard. Short spine areare used primarily for reShort spineboards boards used stairs. Large stretchers often cannot be carried around tight corners and up or SHORT SPINE BOARD lifting him. The patient’s weight increases the friction along moving from vehicles down narrow staircases. The stair chair transports the patient in a sitting posiprimarily forpatients removing patientswhen froma neck or spine injury is suspected. A short spine thewhich track,greatly which helpsthe to length control the rate descent. tion, reduces of patient andofdevice, allowing the EMT vehicles when a neck or spine injury

Spine Boards

board can slide between the patient's back

to maneuver around corners and through narrow spaces. It also has a set of wheels that allow the device to be rolled like a wheelchair over flat surfaces, lessAsstrain withonolder stair chair models, two rescuers are ening the the EMT.

is suspected. short spine board and seat A back. Once secured to can the short boardthe andpatient’s wearing aback rigidand cervical colslide spine between Vacuum Mattress lar, the patient can be moved from a sitting necessary, and a third as a spoiler is preferred when seat back. Once the short Vacuum Mattress Another type of stair chair has come into wide use in F.MS. This chair has wheels position in thesecured vehicle toto a supine position on available. Indications and contraindications for this stair to roll the patient along a floor or level ground but also has a track like system spineaboard andboard, wearing a rigid cervical long spine Often, a vest-type extricaSome services now use a vacuum mattress when patients.The Thepa-pachair are the same as for older models. that allows EMTs device inbeplace of a from short spine “ to gently slide “the patient down a staircase instead of lifting Some services now useis aused vacuum mattress when transporting patients. collar,tion the patient can moved a transporting him. The patient's weight increases the friction along the track,tient whichishelps to board. placed on the device and air is withdrawn by means of a pump. The mattient is sitting placed position on the device air is withdrawn in theand vehicle to a supineby means of a pump. The matcontrol the rate of descent. As with all devices in the Lifeline Academy training, tress then becomes rigid and conforming, padding voids naturally for greater tress then becomes rigid and conforming, padding voids naturally for greater position on a long spine board, Often, there when the stair chair should be used and Vacuum mattresses reduce some of the discomfortassociated associated with comfort. Vacuum mattresses reduce some the discomfort withrigid rigid As with are oldertimes stair chair models, two rescuers are necessary, and a third comfort. as a a vest-type extrication device isofused in spoiler preferred available. Indications and contraindications for this backboards. stair In laterIn later chapters, you will vacuum splintsthat that use use the timesis when it when should not be. The device is often ideal for backboards. chapters, you board. will sec sec vacuum splints thesame sameprinprinplace of a short spine chair arc the same as for older models. patients with difficulty breathing. These patients usually ciple. ciple. Vacuum Mattress find they in must sit up lo breathe more easily, which the be As withthat all devices this chapter, there are times when the stair chair should used timesallows when itthem shouldtonot. often must ideal for patients stairand chair do.The Thedevice stairischair not be with VACUUM MATTRES Some services now use a vacuum mattress when transporting patients. The padifficulty breathing. These patients usually find that they must sit up lo breathe “ usedeasily, for patients neckallows or spine injury, tient is placed on the device and air is withdrawn by means of a pump. The matmore which the with stair chair them to do. Thebecause stair chairthese must not be patients mustwith be immobilized supine on athese backboard to be imtress then becomes rigid and conforming, padding voids naturally for greater used for patients neck or spine injury, because patients must mobilized on injury. a backboard to prevent further injury. comfort. Vacuum mattresses reduce some of the discomfort associated with rigid preventsupine further Unresponsive patients, orUnresponsive those with patients, those with a severely altered mental status, or patients who require airway backboards. In later chapters, you will sec vacuum splints that use the same prina severely altered mental status, or patients who require care may not be transported on the stair chair. ciple. airway care, may not be transported on the stair chair.

STAIR CHAIR

Vacuum Mattress

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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Some services now use a vacuum mattress when transporting patients. The patient is placed on the device and air is withdrawn by means of a pump. The mattress ² Limmer (Brady) then becomes ³ Pollack, (AAOS) rigid and conforming, padding voids ⁴ NHTSA naturally for greater comfort. Vacuum mattresses reduce some of the discomfort associated with rigid backboards. In later chapters, you will sec vacuum splints that use the same principle.

UNIT 1 DAY 6

FOUNDATION OF EMT PRACTICE

To prevent injury when lifting a patient-carrying device, There are situations in which you will find yourself the general rules of body mechanics mentioned earlier apply. reaching for patients or using a considerable amount of Two more methods also can help to injury. Toprevent prevent injury when lifting a to patient-carrying general rulesthat of must effort push and pull adevice, weight.the These are moves

body mechanics mentioned be earlier apply. carefully Two more methods also can help to performed to prevent injury. The first is the power lift.1 so named because prevent injury.it is used UNIT by power weightlifters. It is also known as the squat lift DAY position. In this position, you6willThe squat rather bendlift.atso named first is thethan power because it isREACHING used by power weight lifters. It is GUIDELINES FOR the waist, and you will keep the weight close toas your also known thebody, squat-lift position. In this will squat rather than 1. Keep back in position, locked-inyou position. bend at the and you will keep the weight close to avoid your body, even stradeven straddling it if possible. When rising, yourwaist, feet should 2. When reaching overhead, hyperextended position. dling it if possible. When rising, your feet should be a comfortable distance apart, be a comfortable distance apart, flat on the ground, with the 3. Avoid twisting the back while reaching. To prevent injury when lifting a patient-carrying device, the general rules of flat on with the weight primarily on methods the balls of the weight primarily on the balls of the feet orthe justground, behind them. 4. Application reaching techniques body mechanics mentioned earlier apply. Two of more also canfeet helportojust behind Be sure to raise body Your back should be locked-in. Beprevent sure them. to injury. raiseYour yourback uppershould be•locked-in. Avoid reaching more thanyour 15 toupper 20 inches in befront of your hips. When use you are lowering a patient, use the reverse order of this body before your hips. When you fore are lowering a patient, the body. The first is the power lift. so named because is used bywhere powerprolonged weight lifters. It isthan a minprocedure. the reverse order of this procedure. • Avoid itsituations (more also known as the squat-lift position. ute) In this position, you will squat rather than strenuous effort is needed in order to avoid injury. bend at the waist, and you will keep the weight close to your body, even strad5. Correct reaching for log rolls LIFT dling it if possible. When rising, your feet should be POWER a comfortable distance apart, back while leaning flat on the ground, with the weight• Keep primarily onstraight the balls of the feet orover just patient. be• Lean from the hips. Be sure to your body be- back Using power-lift or raise squat lift upper position, keep When doing power lift or hind them. Your back should be locked-in. • Use into muscles to help with roll. ashoulder patient, usecurvature. the reverse order of this posilocked normal The power-lift squat lift, keep back locked intofore your hips. When you are lowering procedure. tion is useful for individuals with weak knees or normal curvature. The power GUIDELINES FOR PUSHING ANG PULLING thighs. The feet are a comfortable distance apart. lift is useful for individuals with 1.The Push, rather than pull, whenever possible. back is tight and the abdominal muscles lock POWER LIFT weak knees or thighs. The feet are 2.the Keep back back in locked-in. a slight inward curve. Straddle the a comfortable distance apart. The Using power-lift or squat lift position, keep back 3. Keep line of pull through centerweight of body bending object. Keep feet flat. Distribute toby balls of back is tight and the abdominal locked into normal curvature. The power-lift posi- sure feet or just behind them. Stand by making knees. muscles lock the back in a slight tion is useful individuals knees or comes back isforlocked theweak upper body 4.the Keep weight closein to and thewith body. inward curve. Straddle the object. thighs. Thefrom feet are aarea comfortable distance apart. up before the hips. 5. Push the between the waist and shoulder. Keep feet flat. Distribute weight The back is tight and the abdominal muscles lock 6. If weight is below waist level, use kneeling position. to balls of feet or just behind them. Stand by making the back in a slight inward curve. Straddle the 7. Avoid pushing or pulling from an overhead sure the back is locked in and the upper body comes up object. Keep feet flat. Distribute weight to balls of position if The second method is the power grip. Remember your often the possible. feet or just behind them.that Stand by hands makingare sure before the hips. only portion of your body actually in contact with the object you are lifting, 8. Keep elbows bent with arms close to the sides. the back is locked in and the upper body comes mak-

FOUNDATION OF EMT PRACTICE

POWER LIFT

ing your grip a very important element the process. As great an area of your up before thein hips.

The second method is the power grip.and Remember that fingers palms as possibleGUIDELINES should be in with the object. All of your FORcontact CARRYING your hands are often the only portion of your bodybeactually fingers should bent at the possible, keep your hands at 1. same Knowangle. or findWhen out the weight to be lifted. second method the power grip. Remember that your hands are often in contact with the object you are The lifting, yourisgrip least 10making inches apart. 2. Know limitations of the crew’s abilities. the only portion of your bodyofactually in contact with the object you are lifting, maka very important element in the process. As great an area 3. Workininthe a coordinated manner and communicate with your be grip very important process. As great an area of your your fingers and palms as possibleing should inacontact with element partners. fingers and palms as possible should be in contact with the object. All of your the object. All of your fingers should be bent at the same 4. Keep theWhen weight as closekeep toGRIP theyour body as possible. fingers should be bent at the same angle. possible, hands at POWER angle. When possible, keep your hands at least 10 inches 5. Keep back in a locked-in position and refrain from least 10 inches apart. “ apart. twisting. Use power grip to get maximum force from 6.hands. Flex atThe thepalm hips, and not the waist; bendinto at the knees. fingers come complete 7.contact Do notwith hyperextend the back (do not lean back from the the object and all fingers are bent POWER GRIP waist). at the same angles. The power-grip should al“

POWER GRIP

Use power grip to get maximum force from hands. The palm and fingers come into complete contact with the object and all fingers are bent at the same angles. The power-grip should always be used in lifting. This allows for maximum force to be developed. Hands should be at least 10 inches apart. Lift while keeping back in locked -in position. When lowering cot or stretcher, reverse steps. Avoid bending at the waist.

be used in lifting. This allows forfrom maximum Useways power grip to get maximum force hands. and fingers Hands come into complete forceThe to palm be developed. should be at least contact with the object and allkeeping fingers are bent 10 inches apart. Lift while back in locked BABALA: PAGLILIPAT SA cot should at -in the same angles. The power-grip alposition. When lowering or stretcher, rePASYENTE ways be used lifting.bending This allows for maximum verse steps.inAvoid at the waist. force to be developed. Hands should be at least 10 inches apart. Lift while keeping back in locked Hanggang maaari, -in position. When lowering cot or stretcher, reilipat pasyente sakay verse steps.ang Avoid bending at the waist.

ng mga kagamitang may gulong at puwedeng itulak o hilahin.

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Day 6

LIFTING AND CARRYING PATIENTS

PRINCIPLES OF MOVING PATIENTS: EMERGENCY, URGENT AND NON-URGENT MOVES If speed is very important in emergencies, then how quickly should you move a patient? Must you complete your assessment before moving him? How much time should you spend on spinal precautions and other patient-safety measures? The answer is: It depends on the circumstances. If the patient is in a building that is in danger of collapse or a car (hat is on fire, speed is the overriding concern. The patient must be moved to a safe place, probably before you have time to begin or complete an assessment, immobilize ihc patient’s spine, or move a stretcher into position. In this situation, you would use what is known as an emergency move.

UN DA

Sometimes the situation is such that you have time to carry out an abbreviated version of assessment and spinal immobilization. For example, consider the patient who has been trapped in a wreckage, possibly incurring serious injuries. When the patient is extricated, you would place him on a spine board, working quickly to perform the proper assessments and patient care. That move to the spine board is called an urgent move. MGA HAKBANG:

Most of the time, you will be 1. able toMula complete on sayourpagkakahigang scene assessment and care procedures and then move the posisyon ng pasyente, patient onto a stretcher or other device in the normal way. UNIT 1 dalawang FO kaThis would be called a non-urgent move.ilagay ang DAY 6

may sa kanyang dibdib MGA HAKBANG: 2. Hawakan at iangat ang 1. Mula sa pagkakahiga MGA HAKBANG: kanyang katawan at pasyen isuposisyon ng ilagay ang dalawang 1. Mula sa pag porta ang iyong paadibdib sa may sa kanyang posisyon ng BABALA: PARA SA PASYENTE 2. Hawakan at iangat a ilagay ang da kanyang likod. kanyang katawan at may sa kanyan NA MAY DIPRENSYA SA SPINE porta ang iyong paa 2. Hawakan at 3. Hawakan mabuti at iikot kanyang likod. kanyang kata 3. Hawakan mabuti at ii porta ang iyo ang kanyang damit, ang kanyang dam kanyang likod Ang pasyente na hinihinalang may diprensya sa spine ay kailangang protektado gawin ito sa kabila 3. kabilang Hawakan ma gawin din ito sadin ang ulo, leeg at likod bago ito ilipat ng puwesto. Manual stabilization ang dapat gawin ang kanyan bahagi. gawin din ito 4. Pagpalitin ang pang na bahagi. dito at lagyan ito ng matigas na cervical collar hanggang ang pasyente ay mailipat bahagi. suporta sa likod 4. atPagpalitin ang sa spine board. Kung ang pasyente ay nakaupo sa sasakyan, gamitan ito ng maiksing 4. Pagpalitin ang pang nakapasyente humanda suporta sa paghila. spine board o vest bago ito ilipat sa mas mahabang spine board. Kung ang pasyente pasyente at suporta 5.saPumosisyon likodng naaay ngh naman ay nakahiga o nakatayo, ilagay ito agad sa mahabang spine board. Ang sa iyong paghila. kasanayan 5. Pumosisyon pasyente at siguraudhin humanda san MGA HAKBANG: na maa mahabang spine board ay ipapatong sa de-gulong na ambulance stretcher. sa iyong ka ang pagkakakapit siguraudhin paghila. Tandaan: Ang immobilization o hindi pagkilos ay napakaimportante sa isang 1. Mula sa pagkakahigang damit bago ito hilahin. ang pagkak ng pasyente, 6. Siguraduhin na wala pasyente na posibleng may spine injury. 5. posisyon Pumosisyon ng naaayon damit bago ito ilagay ang dalawang kasagabal6. sa iyong Siguraduhin may sa kanyang dibdib kasanayan raanan bago hilahin sa iyong ata sagabal sa 2. Hawakan at iangat ang pasyente. raanan bago kanyang katawan at isusiguraudhin na maayos pasyente. porta ang iyong paa sa kanyang anglikod. pagkakakapit sa 3. Hawakan mabuti at iikot UNIT 1 ito hilahin. damit bago ang kanyang damit, FOU gawin din ito saan kabilang Three situations may require the use of DAY 6 na walang 6. bahagi. Siguraduhin emergency move: 4. Pagpalitin ang pang nakasagabal iyong dasuporta sa likod sa ng The greatest danger in moving a patient quickly pasyente at humanda sa raanan • THE SCENE IS HAZARDOUS. paghila. Hazards maybago make ithilahin ang is the possibility of aggravating a spine injury. In an 5. Pumosisyon ng to naaayon necessary to move a patient quickly in order protect pasyente. emergency, every effort should be made to pull the sa iyong kasanayan at

EMERGENCY MOVES

patient in the direction of the long axis of the body to provide as much protection to the spine as possible. It is impossible to remove a patient from a vehicle quickly and at the same time provide as much protection to the spine as can be accomplished with an interim immobilization device. Therefore, to minimise or prevent aggravation of the injury, move the patient in the direction of the long axis of the body when possible. The long axis is the line that runs down the center of the body from the top of the head and along the spine.

you and the patient. This may occur when na there is siguraudhin maayos ang pagkakakapit uncontrolled traffic, fire or threat of fire, possible sa damit bago ito hilahin. explosions, electrical hazards,6.toxic gases, or Siguraduhin na radiation. walang sagabal sa iyong da• CARE OF LIFE-THREATENING CONDITIONS bago hilahin ang REQUIRES REPOSITIONING. raanan You may have to move pasyente. a patient to a hard, flat surface to provide CPR. or you may have to move a patient to reach life-threatening bleeding. • YOU MUST REACH OTHER PATIENTS. When there are patients at the scene requiring care for lifethreatening problems, you may have to move another patient to access them. MGA HAKBANG:

146

LIFELINE

PREHOSPITAL EMERGENCY CARE

Mula sa pagkakahigang posisyon ng pasyente, ilagay ang dalawang kamay sa kanyang dibdib Hawakan at iangat ang kanyang katawan at isuporta ang iyong paa sa

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

In general, a patient should be moved immediately (emergency move) only when:

NIT 1 AY 6 UNIT 1 DAY 6

•FOUNDATION There is an immediateOF danger to thePRACTICE patient if not EMT moved.UNIT 1 FOUNDATION OF EMT • Fire or danger DAY 6 of fire. OF FOUNDATION EMT PRACTICE • Explosives or other hazardous materials. • Inability to protect the patient from other hazards at CLOTHES DRAG the scene. DRAG • InabilityCLOTHES to gain access to other CLOTHES patients in a vehicle DRAG who need lifesaving care. • General considerations - Life-saving care cannot be given because of the patient’s location or position, e.g., a cardiac arrest patient sitting in a chair or lying on a g bed. • A patient should be moved quickly (urgent move) , when there is immediate threat to life. OUNDATION OF EMT PRACTICE • Altered UNIT mental1 status. FOUNDATION OF EMT DAY 6 • Inadequate breathing. g • Shock (hypoperfusion). ang MGA HAKBANG: • If there is no threat to life, the patient should be moved - CLOTHES nte, DRAG ka1. Mula sawhen pagkakahigang ready for transportation (non-urgent move). gkakahigang a posisyon ng pasyente, ilagay ang dalawang kamay sa kanyang dibdib 2. Hawakan at iangat ang kanyang katawan at isuporta ang iyong paa sa kanyang likod. 3. Hawakan mabuti at iikot ang kanyang damit, gawin din ito sa kabilang bahagi. 4. Pagpalitin ang pang nakasuporta sa likod ng pasyente at humanda sa paghila. 5. Pumosisyon ng naaayon MGA sa HAKBANG: iyong kasanayan at siguraudhin na maayos 1. ang Mula pagkakakapit sa pagkakahigang sa posisyon nghilahin. pasyente, damit bago ito ilagay ang dalawang ka6. Siguraduhin na walang may sa kanyang dibdibdasagabal sa iyong 2. raanan Hawakan at hilahin iangat ang ang bago kanyang katawan at isupasyente. porta ang iyong paa sa kanyang likod. 3. Hawakan mabuti at iikot ang kanyang damit, gawin din ito sa kabilang bahagi. 4. Pagpalitin ang pang nakasuporta sa likod ng pasyente at humanda sa paghila. 5. Pumosisyon ng naaayon sa iyong kasanayan at siguraudhin na maayos ang pagkakakapit sa damit bago ito hilahin. 6. Siguraduhin na walang ² Limmer (Brady) sa iyong da² sagabal Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA ³ Pollack, (AAOS) bago hilahin ang ⁴ raanan NHTSA pasyente.

g pasyente, ang alawang kaisu-dibdib ng sa iangat ang awan at isuikot ong paa sa mit, d. ang at iikot abuti ng damit, oakasa kabilang ng g pang sa nakalikod ng humanda sa yon at ng naaayon ayos asanayan at sa na maayos kakapit sa ang o hilahin. dana walang ang iyong dahilahin ang

t , g

g a

n t s a

• Pulling on the patient’s clothing in the neck and shoulder area. • Putting the patient on a blanket and dragging the blanket. PRACTICE • Putting the EMT-Basic’s hands under the patient’s armpits (from the back) and dragging the patient.

CLOTHES DRAG MGA HAKBANG:

1. Mula sa pagkakahigang posisyon ng pasyente, ilagay ang dalawang kamay sa kanyang dibdib 2. Hawakan at iangat ang kanyang katawan at isuporta ang iyong paa sa kanyang likod. 3. Hawakan mabuti at iikot ang kanyang damit, gawin din ito sa kabilang bahagi.

UNDATION OF EMT PRACTICE g

There are several rapid moves called drags. In this type of move, the patient is dragged by the clothes, the shoulders, or a blanket. These moves are reserved only for emergencies, because they do not provide protection for the neck and PRACTICE spine. Most commonly, a long-axis drag is made from the area of the shoulders. This causes the remainder of the body to fall into its natural anatomical position, with the spine and all limbs in normal alignment. If the patient is on the floor or ground, he can be moved by:

4. Pagpalitin ang pang nakasuporta sa likod ng pasyente at humanda sa paghila. 5. Pumosisyon ng naaayon sa iyong kasanayan at siguraduhin na maayos ang pagkakakapit sa damit bago ito hilahin.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

6. Siguraduhin na walang sagabal sa iyong daraanan bago hilahin ang pasyente.

LIFELINE

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

PREHOSPITAL EMERGENCY CARE

147

FOUNDATION OF EMTDAY PRACTICE FOUNDATION OF EMT EMT PRACTICE PRACTICE tabi ngUNIT pasyente OF 1 6 1. ilagay saFOUNDATION

DAY 6

ng kumot. Bukkumot tulad ng arawan. alim ng kamay ng katawan ang bahagi ng

DAY 6

ang napiling kumot. Buk6 latin ang kumot DAY tulad ng nasa mga larawan. 2. Isingit sa ilalim ng kamay at bahagi ng katawan ang kal;ahating bahagi ng Day 6 ang pasyente kumot. sayo, habang 3. Itagilid ang pasyente ang kabilang papunta sayo, habang g kumot “MGA at “MGA HAKBANG: HAKBANG: kinukuha ang kabilang a ito. bahagi ng kumot at diretcho na ang “MGA HAKBANG: 1. ilagay sa tabi ng pasyente “MGA idretcho HAKBANG: na ito. balik na ang 1. ilagay sa tabi ng pasyente napiling kumot. Buk- Buk- 1. ilagay sa tabi ng pasyente ang napiling kumot. 4. Kapag naidiretcho na ang pasyente ag kanyang UNITpag1 ang ng pasyente latin latin ang kumot tuladtulad ng ng 1. ilagay sa tabi ng pasyente ang kumot kumot, ibalik na ang umot. Bukkumot. BukBukang napiling kumot. DAY 6 ang napilingsakumot. Buknasa larawan. mga larawan. pasyente kanyang pagotdalwang tulad ngdulo nasa mga kumot tulad tulad ng ng latin ang kumot latin ang kumot tulad ng 2. Isingit sa ilalim ng kamay kakahiga. 2. Isingit sa ilalim ng kamay wan.sa bandang larawan. nasa mga larawan. mgaang larawan. tali at bahagi ng katawan ang ang 2. Isingit sa ilalim 5. nasa Kunin dalwang dulo at bahagi ng katawan ngito. kamay ilalim ng ng kamay kamay 2. Isingit sa ilalim ng sa ulunan ng kumot sa kamay bandang bahagi ng ng katawan ang ang tawan ang ng kal;ahating at bahagi ng katawan kal;ahating bahagi at bahagi ng katawan at kunin ang paanan at itali ito. ang kumot. bahagi ng ng kal;ahating bahagi ahagi ng kumot. ng bahagi ng 3.ku- Itagilid ang pasyente 6. kal;ahating Pumwesto bahagi sa ulunan ng kumot. 3. Itagilid ang pasyente kumot. n-dahan itong pasyente at kunin ang ang pasyente 3. Itagilid ang pasyente pasyente papunta sayo, habang papunta sayo, habang 3. Itagilid ang pasyente ggang makuha dalawang bahagi ng kupapunta sayo, sayo, habang habang ,ng habang ang ang kabilang kinukuha kabilang papunta sayo, habang pasyente. kinukuha mot, dahan-dahan itong kinukuha ang kabilang ang kabilang kabilang bahagi ng kumot at kinukuha ang kabilang bahagi ng kumot at g ulunang bairolyo hanggang bahagi ng kumot kumot at at kumot at bahagi ng kumotmakuha at idretcho na ito.na ito. idretcho mot hanggang ² Limmer (Brady) ang porma idretcho na ito. ito. idretcho na ito.ng pasyente. asyente. 4. Kapag naidiretcho na ang 4. Kapag naidiretcho na ang ³ Pollack, (AAOS) 7. Kapag Irolyonaidiretcho ang ulunang 4. Kapag naidiretcho naidiretcho na na ang ang ⁴ 4. chomabuti na angang kumot, NHTSA na angbaibalikibalik na na ang UNIT kumot, ang 1 kumot, ibalik na ang ngna pasyente haging kumot hanggang UNIT 1 ibalik na ang kumot, ibalik na ang ang at pasyente FOUNDATION OF EMT PRACTICE g bahagi sa kanyang pagpasyente sa kanyang pagDAY 6 pasyente sa kumot. pagBukFOUNDATION EMT PRACTICE sa ulo ng kanyang kanyang pagpag-UNIT 1OF pasyente sa pasyente. kanyang pagnyang DAY 6 a paghila. kakahiga. kakahiga. mot tulad ng 8. kakahiga. Hawakang mabuti ang kakahiga. FOUNDATION 5. Kunin ang dalwang dulo dulo 5. Kunin ang dalwang 5. Kunin ang dalwang wan. nakarolyong bahagi 5. 6 Kunin ang dalwang dulo at dalwang dulo dulo DAY wang dulo m ng kamay ng kumot sa bandang ng kumot sa bandang ng kumot sa nghumanda kumot sa sapaghila. bandang sa bandang bandang aatawan bandang ang paanan at italiatito. paanan itali ito. paanan at itali ito. paanan at itali itali ito. ito. to. bahagi ng6. Pumwesto sa ulunan ng ng 6. Pumwesto sa 6. Pumwesto sa ulunan 6. Pumwesto sa ulunan ng sa ulunan ulunan ng ng ulunan ng pasyente at kunin ang pasyente at kunin pasyente at kunin ang ang pasyente at kunin kunin ang ang kunin ang pasyente dalawang bahagi ng kudalawang bahagi ng kudalawang bahagi ng kudalawang bahagi ng kubahagi ng kuagi kuo, ng habang mot, dahan-dahan itong mot, dahan-dahan itong dahan-dahan itong mot, dahan-dahan itong mot, dahan-dahan itong “MGA HAKBANG: ahan itong g kabilang “MGA HAKBANG: irolyo hanggang makuha irolyo hanggang 1. Ipuwesto sa tabi ng pasyente hanggang makuha makuha irolyo hanggang makuha irolyo hanggang makuha ngkumot makuha at 1. ilagay sa tabi ng pasyente ang porma ng pasyente. “MGA HAKBANG: ang porma ng pasyente. ng pasyente. 1. ilagay sa tabi ng pasyente ang porma ng pasyente. ang napiling kumot. Buklatin ang porma ng pasyente. pasyente. o. ang napiling kumot. Buk7. Irolyo ang ulunang ba7. Irolyo ang ulunang baang napiling kumot. Bukulunang ba7. Irolyo ang ulunang ba-mga latin ang kumot tulad ng angkumot ulunang ba-nasa 1. ilagay sa tabi ng pasyente ang tulad ng tcho na ang unang ba-7. Irolyo haging kumot hanggang latin mga ang larawan. kumot tulad ng haging kumot hanggang kumot hanggang nasa ang napiling kumot. Bukhaging kumot hanggang haging kumot hanggang khanggang na ang nasa mga larawan. sa ulo ng pasyente. larawan. latin ang kumot tulad ng 2. Isingit sa ilalim ng kamay sa ulo ng pasyente. pasyente. 2.ngat Isingit sa ng ilalim ng kamay anyang pagulo pasyente. sa ulo pasyente. nte. nasa mga larawan. bahagi ang8. UNIT8.1 Hawakang mabuti ang 2.sang Isingit sa ilalim ngkatawan kamay Hawakang mabuti ang mabuti ang at bahagi ng katawan ang 2. Isingit sa ilalim ng kamay kal;ahating bahagi ng 8. Hawakang angng nakarolyong bahagi at abuti ang8. Hawakang mabuti ang FOUNDATION kal;ahating bahagi nakarolyongat bahagi bahagi at at bahagi ngmabuti katawan ang bahagi atDAY ng katawan ang 6 kumot. alwang humanda sa paghila. nakarolyong bahagi at bahagi dulo at nakarolyong bahagi at kumot. kal;ahating bahagi ng paghila. 3. Itagilid angng pasyente paghila. kalahating kumot. humanda sakumot. sa bandang 3. paghila. Itagilid ang ghila. humanda sabahagi paghila. humanda sa sayo, pasyente habang ito. papunta sayo, papunta habang 3. Itagilidpapunta ang pasyente 3. Itagilid ang pasyente kinukuha ang kabilang kinukuha ang kabilang papunta sayo, habang ulunan ng bahagi kinukuha ng kumot at sa iyo, habang bahagi ng kumot ang at kinukuha ang kabilang kunin ang idretcho na ito. idretcho nang ito.kumot at bahagi ng kumot at kabilang bahagi 4. Kapag naidiretcho na ang hagi ng ku4. Kapag naidiretcho na ang idretcho na ito. kumot, ibalik na ang ituwid na ito. dahan itong kumot, ibalik na ang 4. Kapag naidiretcho na ang ² Limmer (Brady) pasyente sa kanyang pagpasyente sa kanyang pagkumot, ibalik na ang 4.³ Pollack, Kapag (AAOS) naituwid ang makuha kakahiga. na ang kumot, ⁴ NHTSA pasyente sa kanyang pagkakahiga. pasyente. 5. na Kunin dalwangsadulo ibalik ang ang pasyente “MGAkakahiga. HAKBANG: 5. Kunin ang dalwang dulo ng kumot sa bandang lunang ba5. Kunin ang dalwang dulo ngpagkakahiga. kumot sa bandang kanyangpaanan at itali ito. 1. ilagay sa tabi ng ng kumot sa pasyente bandang t hanggang paanan at itali ito. 6. ang Pumwesto sa ulunan ng ang napiling Buk5. Kunin dalawang dulo ngng paanan at italikumot. ito. 6. Pumwesto sa ulunan ente. pasyente at kunin ang latin ang kumot tulad ng 6. Pumwesto sa ulunan ng pasyente at kunin ang kumot sa bandang paanan at itali mabuti ang dalawang nasa mga larawan. pasyente at kunin ang dalawang bahagi bahagi ng ng kuku2. Isingit sa ilalim ng kamay mot, dahan-dahan itong bahagi at ito. mot, dahan-dahan itong dalawang bahagi ng kuatmot, bahagi ng katawan itong ang irolyo hanggang makuha dahan-dahan aghila. irolyosa hanggang makuha 6. Pumwesto ulunan ng

FOUNDATION OF

LIFTING AND CARRYING PATIENTS

FOUNDATION OF EMT PRACTICE

BLANKET DRAG

OF EMT PRACTICE

MGA HAKBANG:

kal;ahating bahagi ng irolyo hanggang makuha kumot. ang porma ng pasyente. 3.7. Itagilid angulunang pasyente Irolyo ang bapapunta sayo, hanggang habang haging kumot kinukuha ang kabilang sa ulo ng pasyente. ng mabuti kumot ang at 8. bahagi Hawakang idretcho na ito. bahagi at nakarolyong 4. Kapag naidiretcho na ang humanda sa paghila. ng pasyente. kumot, ibalik na ang 7. Irolyo ang ulunang bahagi ng pasyente sa kanyang pagkakahiga. kumot hanggang sa ulo ng 5. Kunin ang dalwang dulo pasyente. ng kumot sa bandang ² Limmer (Brady) paanan at itali ito. 8. (AAOS) Hawakang mabuti ang ³ Pollack, 6. Pumwesto sa ulunan ng Limmer (Brady) ⁴ NHTSA ² Limmer ²(Brady) Pollack, (AAOS) pasyente at kunin ang nakarolyong bahagi at ³ Pollack, ³(AAOS) ⁴ NHTSA⁴ NHTSA dalawang bahagi ng kuhumanda sa paghila. mot, dahan-dahan itong irolyo hanggang makuha ang porma ng pasyente. 7. Irolyo ang ulunang bahaging kumot hanggang sa ulo ng pasyente. 8. Hawakang mabuti ang nakarolyong bahagi at humanda sa paghila.

UNIT 1 DAY 6

OF EMT PRACTICE

MG 1.

2. ² Limmer (Brady)

ang ng ang porma ng pasyente. pasyente. 7. ang bapasyente atporma kunin ang 7. Irolyo Irolyo ang ulunang ulunang bahaging kumot hanggang haging kumot hanggang dalawang bahagi ng kumot, sa sa ulo ulo ng ng pasyente. pasyente. 8. dahan-dahan itongmabuti irolyoang 8. Hawakang Hawakang mabuti ang nakarolyong bahagi at nakarolyong bahagi at hanggang makuha ang porma humanda sa paghila. humanda sa paghila.

148

LIFELINE

Limmer (Brady) (Brady) ²² Limmer Pollack, (AAOS) (AAOS) ³³ Pollack, NHTSA ⁴⁴ NHTSA

MGA HAKBANG: 1. ² Limmer (Brady)

² Limmer (Brady) Limmer(AAOS) (Brady) ³²Pollack, ⁴³ Pollack, NHTSA (AAOS) ⁴ NHTSA

³ Pollack, (AAOS) ⁴ NHTSA

2. 3. 4.

PREHOSPITAL EMERGENCY CARE

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

³ Pollack, (AAOS) ⁴ NHTSA

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

Sa tulong ng dalawang tao, hawakan ang magkabilang bahagi ng kumot sa bandang gitna Itupi ang dalawang gilid papunta sa gitna. Ayusin ito at pagsamahin yung dalawang bahagi ng kumot. Baligtarin ang hawak at tupiin muli ang kumot ng isang beses sa magkabilang dulo. Pagsamahin ang dalawang bahagi.

FOUNDATION OF EMT PRACTICE

DAY 6

F EMT PRACTICE

1 SIMPLE KNOTUNIT TYING DAY 6

FOUNDATION OF EMT PRACTICE BLANKET FOLDING

SIMPLE KNOT TYING UNIT 1 DAY 6

MGA HAKBANG: 1.HAKBANG: Kunin ang magkabilang MGA MGA HAKBANG:

FOUNDATION OF EMT PRACTICE BLANKET FOLDING

dulo ng kumot sa bandang MGA HAKBANG: 1. 1.kunin angang magkabilang kunin magkabilang paanan ng pasyente, 1. kunin ang magkabilang dulo kumot bandulo ng ng kumot sa sa bandulo ng kumot sa band ag n g p a pa anaanna n n gn g dan 2. pasyente, Pagpatungin at ilusot ang dang paanan ng pasyente, pasyente, 2.Pagpatungin Pagpatungin atisa ilusot ang isang dulo sa pang dulo 2. at ilusot ang UNIT 1isang dulo sa isa pang Pagpatungin at ilusot ang isangng dulo EMT PRACTICE kumotsaFOUNDATION atisa iikotpang ito. Ulitin 2. OF DAY 6dulo isang dulo sa isa pang ng kumot at iikot ito. dulo ng kumot at iikot ito. ng isangpang beses. dulo ng kumot at iikot ito. Ulitin pang beses. Ulitin ng isa isa pang beses. Ulitin ng isa pang beses. Maarri ding gamitin ang 3. 3.Maarri ding gamitin ang BLANKET FOLDING 3. Maarri ding gamitin ang Knot” kung mas 3. “Square Maarri dingkung gamitin ang “Square Knot” mas “Square Knot” kung mas komportable itong gawin komportable itong gawin “Square Knot” kung mas komportable itong gawin sa taga paglunas. UNIT UNIT 11 sa taga paglunas. komportable itong gawin sa sa taga paglunas.

UNIT 1 FOUNDATION FOUNDATION OF OF EMT EMT PRACTICE PRACTICE FOUNDATION OF EMT PRACT DAY 6

DAY DAY 66 MGA HAKBANG:

taga paglunas.

MGA HAKBANG:

BLANKET BLANKET FOLDING FOLDING BLANKET FOLDING

kunin ang magkabilang kumot sa banFOUNDATIONdulo OFngEMT PRACTICE 4. dang paanan ng MGA HAKBANG: pasyente, 1. Sa ang tulong ng dalawang 2. FOLDING Pagpatungin at ilusot BLANKET 5. hawakan ang magisang dulo sa isa tao, pang kabilang bahagi ng kumot dulo ng kumot at iikot ito. sa bandang gitna UNIT 1 Itupi ang dalawang gilid Ulitin ng isa pang2.beses. FOUNDATION OF EMT PRACTICE UNIT UNIT11 DAY 6ding gamitinpapunta 3. Maarri ang sa gitna. ² Limmer (Brady) FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE 3. Ayusin ito at pagsamahin DAY DAY 6 6 ³ Pollack, (AAOS) “Square Knot” kungyung masdalawang bahagi ² Limmer (Brady) ² Limmer (Brady) ⁴ NHTSA ³ Pollack, (AAOS) ³ Pollack, (AAOS) ng kumot. komportable itong gawin ⁴ NHTSA ⁴ NHTSA ang hawak at FOLDING sa taga paglunas.4. BaligtarinBLANKET

GA HAKBANG: 5.

tupiin muli ang kumot ng isang beses sa magkabilang dulo. Pagsamahin ang dalawang bahagi.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

BLANKET FOLDING

MGA HAKBANG:

BLANKET BLANKETFOLDING FOLDING

MGA MGAHAKBANG: HAKBANG: 1. 1. Sa Sa tulong tulong ng ng dalawang dalawang tao, tao, hawakan hawakan ang ang magmagkabilang kabilang bahagi bahagi ng ng kumot kumot sa sabandang bandanggitna gitna 2. 2. Itupi Itupi ang ang dalawang dalawang gilid gilid ² Limmer (Brady) papunta papunta sa sagitna. gitna. ³ Pollack, (AAOS) ⁴ NHTSA 3. 3. Ayusin Ayusin ito ito at at pagsamahin pagsamahin yung dalawang dalawang bahagi bahagi ² Limmer (Brady) yung ³ Pollack, (AAOS) ng ngkumot. kumot. ⁴ NHTSA 4. 4. Baligtarin Baligtarin ang ang hawak hawak at at tupiin tupiin muli muli ang ang kumot kumot ng ng isang isang beses beses sa sa magkabimagkabilang langdulo. dulo. 5. 5. Pagsamahin Pagsamahin ang ang daladalawang wangbahagi. bahagi.

1. Sa tulong ng dalawang tao, hawakan ang magkabilang bahagi ng kumot sa bandang gitna 2. Itupi ang dalawang gilid papunta sa gitna. 3. Ayusin ito at pagsamahin yung dalawang bahagi ng kumot. 4. Baligtarin ang hawak at tupiin MGA HAKBANG: muli ang kumot ng isang beses sa MGA MGA HAKBANG: HAKBANG: 1. Sa tulong ng dalawang magkabilang dulo. tao, hawakan ang mag1. 1. Sa Sa tulong tulongngngdalawang dalawang ang dalawang bahagi. kabilang bahagi5.ngPagsamahin kumot tao, tao,hawakan hawakanang angmagmag-

MGA HAKBANG: 1.

2. 3. 4.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

2. 3. 4.

sa bandang gitna Itupi ang dalawang gilid papunta sa gitna. Ayusin ito at pagsamahin yung dalawang bahagi ng kumot. Baligtarin ang hawak at tupiin muli ang kumot ng isang beses sa magkabilang dulo. Pagsamahin ang dalawang bahagi.

kabilang kabilang bahagi bahagi ngng kumot kumot sasa bandang bandang gitna gitna 2.2. Itupi Itupiang angdalawang dalawanggilid gilid papunta papunta sasa gitna. gitna. 3.3. Ayusin Ayusinitoitoatatpagsamahin pagsamahin yung yung dalawang dalawang bahagi bahagi ngng kumot. kumot. 4.4. Baligtarin Baligtarinang anghawak hawakatat tupiin tupiinmuli muliang angkumot kumotngng isang isangbeses besessasamagkabimagkabilang lang dulo. dulo. 5.5. Pagsamahin Pagsamahin ang ang daladalawang wang bahagi. bahagi.

LIFELINE ² ²Limmer Limmer(Brady) (Brady) ³ ³Pollack, Pollack,(AAOS) (AAOS) ⁴ ⁴ NHTSA NHTSA

² Limmer (Brady)

³ Pollack, (AAOS) ⁴ NHTSA

PREHOSPITAL EMERGENCY CARE

149

DATION OF EMT PRACTICE Day 6

LIFTING AND CARRYING PATIENTS 4.

MGA MGA HAKBANG: HAKBANG: 1. 1. iilagay iilagay ang ang kamay kamay sa sa ila-ilalaim laim ngng kili-kili kili-kili ngng pasyente, pasyente, maaring maaring hawahawakankan ang ang magkabilang magkabilang braso brasongngmagkabilang magkabilang kamay. kamay. 2. 2. Itagilid Itagilid ngng konti konti ang ang iyong iyong katawan. katawan. Tignan Tignan ang ang da-daraanan raanansa samaaring maaringsa-sagabal gabal o hagdanan o hagdanan . . 3. 3. Iatras Iatras ang ang paa paa sa sa likuran likuran at athatakin hatakinbahagya bahagyaang ang payente, payente, isunod isunod ang ang paapaa sa sa harapan harapan at at hatakin hatakin ulitulit bahagya bahagya ang ang pasyente. pasyente. 4. 4. Ulit-ulitin Ulit-ulitinang angganitong ganitong h ahkabkabnagn g h ahnagnggagnagn g maibaba maibaba ngng hagdan hagdan ang ang pasyente. pasyente. 5. 5. Kapag Kapag ang ang paapaa ay ay nasa nasa gilid gilid nana ngng hagdan hagdan dahan dahan dahanin dahaninitong itongilaylay ilaylaysa sa bawat bawat baiting baiting upang upang maimaiwasan wasan dindin ang ang karagdakaragda1. Iposisyon ang kamay gang gang kondisyon. kondisyon.

UNIT1 1 UNIT UNIT DAY61 61 UNIT DAY DAY DAY6 6

FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE FOUNDATION FOUNDATION FOUNDATIONOF OFEMT EMT PRACTICE PRACTICE

MGA HAKBANG:

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

sa ilalaim ng kili-kili ng pasyente. Maaring hawakan ang magkabilang braso ng magkabilang kamay.

2. Itagilid nang konti ang iyong katawan. Tignan ang daraanan sa maaring sagabal o hagdanan. MGA HAKBANG:

MGA HAKBANG: MGA HAKBANG: MGA HAKBANG: 3. Iatras ang paa sa likuran 1. iilagay ang kamay ila1. iilagay ang kamay sa sa ila-ang at hatakin bahagya 1.laim iilagay ang kamay sa ilalaim ng kili-kili ng kili-kili ng payente, isunod 1. iilagay ng ang kamay sa ang ila-paa laim ng kili-kili ng pasyente, maaring hawaharapan athawahatakin pasyente, maaring laim ngsa kili-kili ng ulit pasyente, maaring hawakan ang magkabilang bahagya ang pasyente. kan ang magkabilang pasyente, maaring hawakan ang magkabilang braso magkabilang braso ngngmagkabilang kan ang magkabilang braso ng magkabilang 4.ngUlit-ulitin ang ganitong kamay. kamay. braso magkabilang kamay. hakbang hanggang maibaba 2. Itagilid ng konti ang iyong 2. Itagilid ng konti ang iyong 2.kamay. Itagilid ng ngTignan kontiang ang iyong hagdan pasyente. katawan. ang angiyong da-da2. katawan. Itagilid ngTignan konti ang katawan. Tignan ang daraanan sa maaring saraanan maaring sakatawan. Tignan ang 5.osaKapag paa. aydanasasaraanan sa ang maaring gabal hagdanan gabal o hagdanan . . saraanan sa maaring na ng hagdan gabal ogilid hagdanan Iatras ang paa sa likuran 3. 3.3.Iatras ang paa sa likuran gabal o hagdanan .sa dahan dahanin itong Iatras ang paa likuran at hatakin bahagya ang hatakin bahagya ang ilaylay sasa bawat baiting 3. at Iatras ang paa likuran at hatakin bahagya ang payente, isunod ang upang maiwasan dinpaa ang payente, isunod angang paa at payente, hatakin bahagya ang isunod paa sa harapan at hatakin ulit karagdagang kondisyon. sa harapan at hatakin ulit payente, isunod ang paa sa harapan atpasyente. hatakin ulit ang bahagya ang pasyente. sa bahagya harapan at hatakin ulit bahagya ang pasyente. Ulit-ulitin ang ganitong 4. 4.4.Ulit-ulitin ang ganitong bahagya ang pasyente. Ulit-ulitin ang ganitong g h ahnganitong a nggagnagn g ahkhabakakbnbagannang 4. hUlit-ulitin g hg anggang maibaba ng hagdan maibaba ng ng hagdan h a kmaibaba bang h ahagdan n g g aang nang g ang pasyente. pasyente. maibaba ng hagdan ang pasyente. Kapag ang nasa 5. 5.5.Kapag ang paapaa ay ay nasa pasyente. Kapag ang paa ay nasa gilid na ng hagdan dahan na ang ng hagdan 5. gilid Kapag paa aydahan nasa gilid na ng hagdan dahan dahanin itong ilaylay 150 PREHOSPITAL EMERGENCY dahanin itong ilaylay sa sa gilid naLIFELINE ng hagdan dahan dahanin itong ilaylay saCARE bawat baiting upang maibawat baiting upang maibawat baiting upang maidahanin itong ilaylay sa wasan ang karagdawasan dindin ang karagdawasan din ang karagdabawat baiting upang maigang kondisyon. gang kondisyon. gang kondisyon. wasan din ang karagdagang kondisyon.

katawan. Tignan ang daraanan sa maaring sagabal o hagdanan . Iatras ang paa sa likuran at hatakin bahagya ang payente, isunod ang paa sa harapan at hatakin ulit bahagya ang pasyente. Ulit-ulitin ang ganitong hakbang hanggang maibaba ng hagdan ang pasyente. Kapag ang paa ay nasa gilid na ng hagdan dahan dahanin itong ilaylay sa bawat baiting upang maiwasan din ang karagdagang kondisyon.

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

URGENT MOVES Urgent moves are required when the patient must be moved quickly for treatment of an immediate threat to life. However, unlike emergency moves, urgent moves are performed with precautions for spinal injury.

Examples in which urgent moves may be required include the following: • The required treatment can only be performed if the patient is moved. A patient must be moved in order to support inadequate breathing or to treat for shock or altered mental status. • Factors at the scene cause patient decline. If a patient is rapidly declining because of heat or cold, for example, he may have to be moved. Moving a patient onto a long spine board, also called a backboard, is an urgent move used when there is an immediate threat to life and suspicion of spine injury. If the patient is supine on the ground, follow these steps: 1. A log-roll maneuver must be performed to move him onto his side. 2. The spine board is then placed next to the patients body, and he is logrolled onto the board. 3. After the patient is secured and immobilized on the spine board, the board and patient are lifted together onto a stretcher, the board is secured to the stretcher, and 4. The stretcher with spine board and patient firmly secured arc loaded into the ambulance. (When reaching across the patient to perform a log roll, remember the principles of body mechanics: Keep your back straight, lean from the hips, and use your shoulder muscles to help with the roll.

Urgent Move: Onto Long Spine Board • Used if immediate threat to life and suspicion of spine injury. • Patient supine, log-roll onto side. • Place spine board next to body; log-roll onto board. • Lift onto stretcher • Secure stretcher; load into ambulance

Urgent Move: Rapid extrication of patient sitting in vehicle Another example of an urgent move is the rapid extrication procedure from a vehicle. If the patient has critical injuries, taking the time to immobilize him with a short backboard while he is still in the car may cause a deadly delay. During a rapid extrication. EMTs use a quicker procedure: They stabilize the spine manually as they move the patient from the car onto a long spine board.

Follow these steps : 1. One EMT gets behind patient and brings cervical spine into neutral in-line position and provides manual immobilization. 2. A second EMT applies cervical immobilization device as the third EMT first places long backboard near the door and then moves to the passenger seat. 3. The second EMT supports the thorax as the third EMT frees the patient’s legs from the pedals. 4. At the direction of the second EMT, he and the third EMT will rotate the patient in several short, coordinated moves until the patient’s back is in the open doorway and his feet are on the passenger seat. 5. Since the first EMT usually cannot support the patient’s head any longer, another available EMT or a bystander supports the patient’s head as the first EMT gets out of the vehicle and takes support of the head outside of the vehicle. 6. The end of the long backboard is placed on the seat next to the patient’s buttocks. Assistants support the other end of the board as the first EMT and the second EMT lower the patient onto it. 7. The second EMT and the third EMT slide the patient into the proper position on the board in short, coordinated moves. 8. Several variations of the technique are possible, including assistance from bystanders. All these must be accomplished without compromise to the spine

LIFELINE

PREHOSPITAL EMERGENCY CARE

151

Day 6

Follow these steps: Follow these steps: 1. Two or three rescuers line up on one side of the patient. 1. or three rescuers line up on one side of patient. 2. Two Rescuers kneel on one knee (preferably thethe same for all rescuers). 2. kneelarms on one (preferably the same for all rescuers). 3. Rescuers The patient's areknee placed on his chest if possible. 3. arehead placed on hisone chestarm if possible. 4. The The patient's rescuer arms at the places under the patient's neck 4. The atand the cradles head places one arm under patient's neckarm and rescuer shoulder the patient's head. Hethe places his other and shoulder and cradles patient's head. He places his other arm under the patient's lowerthe back. the patient's lower back. 5. under The second rescuer places one arm under the patient's knees and 5. The rescuer places one arm under the patient's knees and one second arm above the buttocks. the buttocks. 6. one If a arm thirdabove rescuer is available, he should place both arms under the 6. If a third rescuer is available, he should place both arms under the waist and the other two rescuers slide their arms either up to the waist and the other two rescuers slide their arms either up to the mid-back or down to the buttocks as appropriate. mid-back or down to the buttocks as appropriate. 7. On signal, signal, therescuers rescuers thepatient patient their knees the On the liftliftthe to to their knees andand rollroll the pa- paas to 7. prevent injury or additional injury to the patient and tientin intoward towardtheir theirchests. chests. tient to avoid discomfort and pain. In a non-urgent move, the 8. On On signal, signal,the therescuers rescuersstand standand and move patient to the stretcher. 8. move thethe patient to the stretcher. 9. isTo Tomoved lowerthe the patient, the steps reversed.assessment and patient from the site ofareare on-scene 9. lower patient, the steps reversed.

LIFTING AND CARRYING PATIENTS

NON-URGENT MOVES

When there is no immediate threat to life, the patient should be moved when ready for transportation, using a non-urgent move. On-scene assessment and any needed onscene treatments, such as splinting,“ “should be completed first. Non-urgent moves should be carried out in such a way

treatment (perhaps a bed or sofa, perhaps the floor or the ground outdoors) onto a patient-carrying device.

Direct ground lift (no suspected spine injury) UNIT 1 UNIT A direct ground lift is performed when a patient with no 1 1 UNIT UNIT 1 UNIT 1 DAY 6 DAY suspected spine injury needs to be lifted from the ground to 6 6 UNIT 1 DAY UNIT 161 UNIT DAY 6 DAY a stretcher. DAY 6 DAY66 DAY

FOUNDATION OF EMT PRACTICE FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE FOUNDATION FOUNDATION OF EMT PRACTICE FOUNDATION OF EMT PRACTICE FOUNDATION OF EMT PRACTICE FOUNDATION OF EMT PRACTICE FOUNDATION

Follow these steps:

1. Two or three rescuers line up on one side of the patient. 2. Rescuers kneel on one knee (preferably the same for all rescuers). 3. The patient’s arms are placed on his chest if possible. 4. The rescuer at the head places one arm under the patient’s neck and shoulder and cradles the patient’s MGA HAKBANG: MGA HAKBANG: MGA HAKBANG: head. He places his other arm under the patient’s lower MGA HAKBANG: MGA HAKBANG: HAKBANG: ng tatlo o 1.MGA Kinakailangan MGA HAKBANG: ng tatlo o back. Kinakailangan MGA HAKBANG: 1. 1. Kinakailangan ngngtatlo pang Tagalunas 1. higit Kinakailangan tatloo sa o 1. 1.under Kinakailangan ngngtatlo higit pang Tagalunas sao Kinakailangan tatlo higit pang Tagalunas saosa 5. The second rescuer places one arm the patient’s higit pang Tagalunas teknik na ito. 1. Kinakailangan ng tatlo o higit pang Tagalunas saosa higit pang Tagalunas 1. Kinakailangan ng gilid tatlo teknik na teknik na ito.ito. teknik na ito. 2. Pumosisyon sa ng higit pang Tagalunas sa knees and one arm above the buttocks. teknik na ito.ito. teknik na higit pang Tagalunas sa Pumosisyon sa gilid ng 2. 2.2.Pumosisyon sa gilid ngng Pumosisyon sa gilid pasyente ng nakahanay teknik naito. ito. Pumosisyon sa gilidngng 2. 2.pasyente Pumosisyon sa gilid teknik na pasyente ng nakahanay 6. If a third rescuer is available, he should place both ng nakahanay pasyente ng mula sa pinakamatangkad Pumosisyon sanakahanay gilid ng ng pasyente nakahanay 2.2.mula Pumosisyon sa gilid pasyente ngng nakahanay mula sa pinakamatangkad sa pinakamatangkad mula sa pinakamatangkad sa tapat ng ulo ng arms under the waist and the other sa two rescuers slide pasyente ng nakahanay nakahanay mula sa pinakamatangkad pasyente ng mula sa pinakamatangkad sa tapat ng ulo ng tapat ng ulo ng sa tapat ng ulo ng pasyente. mula sapinakamatangkad pinakamatangkad satapat tapat ngthe mula sa saor ng uloulo ngng their arms either up to the mid-back down to pasyente. pasyente. 3. pasyente. Lumuhod ng sa tapat ng ng parepareulo ng ng pasyente. sa tapat ulo pasyente. Lumuhod ng parepareLumuhod ngparepare3. 3.3.Lumuhod ng hong paa ang nakataas at buttocks as appropriate. pasyente. Lumuhod ng pareparepasyente. 3. 3.hong Lumuhod ng pareparehong paa ang nakataas hong ang nakataas paapaa ang nakataas at at nakaluhod. Lumuhod ng pareparehong paa ang nakataas at 7. On signal, the rescuers lift the patient to their knees 3.3.nakaluhod. Lumuhod ng pareparehong paa ang nakataas at nakaluhod. nakaluhod. 4. Itapat ang palad sa sahig hong paaang ang nakataas nakaluhod. hong paa nakataas atat nakaluhod. Itapat ang palad sahig Itapat ang palad 4. 4.4.chests. Itapat ang palad sa sa sahig and roll the patient in toward their at ipasok ng sabay sabay nakaluhod. 4. Itapat ang palad sa sahig nakaluhod. 4. 4.at Itapat ang sapapunta sahig at ipasok ng sabay at ipasok ng sabay sabay ipasok ngpalad sabay sabay ang mga kamay Itapat ang palad sa sahig at ipasok ng sabay sabay 8. On signal, the rescuers stand and 4.move the patient to ang palad sa sahig atItapat ipasok ng sabay sabay ang mga kamay ang mga kamay papunta ang mga kamay papunta sa kabilang bahagi, iikot at ipasok ng sabay sabay ang mga kamay papunta at ipasok ng sabay sabay ang mga kamay papunta sa kabilang bahagi, iikot sa kabilang bahagi, the stretcher. sa kabilang bahagi, iikot ang mga kamay kamay upang ang papunta sa kabilang bahagi, iikot mga kamay papunta ang mgakamay kamay saang kabilang bahagi, iikot ang mga kamay upang ang mga upang sa kabilang bahagi, iikot mahawakang mabuti ang 9. To lower the patient, the steps are reversed. ang mga kamay upang sa kabilang bahagi, iikot mahawakang mabuti ang ang mga kamay upang mahawakang mabuti ang

² Limmer (Brady) ³ Pollack, (AAOS) ²⁴ Limmer NHTSA (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

mahawakang mabuti ang ang mga kamay upang katwan ng pasyente. mahawakang mabuti ang ang mga kamay upang katwan ng pasyente. mahawakang mabuti ang katwan pasyente. ngng pasyente. mahawakang mabuti ang 5. katwan Sa bilang ng tatlo, sabay katwan ng pasyente. mahawakang mabuti ang 5. Sa bilang ng tatlo, sabay katwan ngng pasyente. Sa bilang ng tatlo, sabay 5. 5.5.Sa bilang tatlo, sabay katwan ng pasyente. sabay buhatin ang Sa bilang ng tatlo, sabay katwan ng pasyente. sabay buhatin ang 5. 5.sabay Sasabay bilang ng tatlo, buhatin ang Sa bilang ng tatlo,sabay sabay buhatin ang pasyente habang inaansabay buhatin ang 5. sabay Sa bilang buhatin ng tatlo, sabay pasyente habang inaanang pasyente habang inaansabay buhatin ang pasyente inaangat anghabang inyong mga paa pasyente habang inaansabay buhatin ang gat ang inyong mga paa pasyente habang inaanpasyente habang inaangat ang inyong mga paa gat ang inyong mga paa para magsibling suporta gat ang inyong mga paa pasyente habang inaanpara magsibling suporta gat ang inyong mga paa gat ang inyong mga paa para magsibling suporta para magsibling sa katawan nito. suporta para magsibling suporta gat ang inyong paa sa katawan nito. mga para magsibling suporta para magsibling suporta katawan nito. Tatlo o higit pang dami ng EMTs ang6.6.kailangan para gawin ang sasa katawan nito. Iclip o yakapin ang sa katawan nito. para magsibling suporta Iclip o nito. yakapin ang saIclip katawan sa katawan nito. yakapin ang 6. 6.6.Iclip o ooyakapin ang pasyente habang sabay Iclip yakapin ang technique na ito. sa katawan nito. pasyente habang sabay Iclip yakapin ang 6. 6.pasyente Iclip onaohabang yakapin ang sabay pasyente habang sabay sabay tumatayo pasyente habang sabay 6. Iclip o yakapin ang sabay na tumatayo pasyente habang sabay pasyente habang sabay Pumosisyon sa gilid ng pasyente nang7.7.sabay nakahanay nang ayon sa na tumatayo sabay na tumatayo sabay na tumatayo Ilagay ang pasyente sa pasyente habang sabay Ilagay ang pasyente sa sabay na tumatayo sabay na tumatayo ang pasyente sa sa Ilagay ang pasyente sa 7.7.Ilagay Ilagay ang pasyente gilid ng stretcher, dahan– tangkad. Ang pinakamatangkad ay 7.7. dapat nasa uo ng pasyente. gilid ng stretcher, dahan– sabay na tumatayo 7.gilid Ilagay ang pasyente Ilagay ang pasyente sasa gilid ng stretcher, dahan– ngng stretcher, dahan– gilid stretcher, dahan– dahang igitna ang katadahang igitna ang kata7. Ilagay ang pasyente sa gilid stretcher, dahan– Lumuhod gamit ang kaliwang paa. dahang gilid ngng stretcher, dahan– dahang igitna ang kataang katadahang igitna ang katawan ng pasyente sa wan ng pasyente sa gilid ngigitna stretcher, dahan– dahang ang katadahang igitna katawan ngigitna pasyente sa wan ngng pasyente sa stretcher. wan pasyente sa Ipasok ang mga mga kamay nang patihaya papunta saang stretcher. dahang igitna ang katawan ng pasyente wan ng pasyente sasa stretcher. stretcher. stretcher. wan ng kamay pasyente sa kabilang bahagi. Pasalo dapat ang porma ng mga para stretcher. stretcher. stretcher.

MGA HAKBANG: 1. 2. 3. 4.

mahawakang mabuti ang katawan ng pasyente. 5. Bumilang ng tatlo at sabay-sabay buhatin ang pasyente habang iniaangat ang inyong mga paa para magsilbing suporta sa katawan nito. 6. Yakapin ang pasyente habang sabay-sabay na tumatayo. 7. Ilagay ang pasyente sa gilid ng stretcher. Dahan-dahang igitna ang katawan nito sa stretcher. 152

LIFELINE

PREHOSPITAL EMERGENCY CARE ²²Limmer Limmer(Brady) (Brady) ³³²Pollack, Limmer (Brady) Pollack,(AAOS) (AAOS) ⁴⁴³² NHTSA Pollack, (AAOS) ² Limmer (Brady) NHTSA (Brady) ² Limmer Limmer (Brady) ⁴³ Pollack, NHTSA ³ Pollack, (AAOS) (AAOS) ³ Pollack, (AAOS) (Brady) ²Limmer Limmer (Brady) ⁴ ²NHTSA ⁴⁴ NHTSA NHTSA ³ ³Pollack, Pollack,(AAOS) (AAOS) ⁴ ⁴NHTSA NHTSA

ground ground or or from from a sitting a sitting position. position. MGA MGA HAKBANG: HAKBANG: MGA MGA HAKBANG: HAKBANG:

Follow Follow these these steps: steps: Follow Follow these these steps: steps: 1. 1. One One rescuer rescuer kneels kneels at the at the patient's patient's head head andand oneone kneels kneels at the at the patient's patient's 1. 1.One One rescuer rescuer kneels kneels at at thethe patient's patient's head head and and one one kneels kneels at at thethe patient's patient's sideside by by his his knees. knees. side side byby hishis knees. knees. 2. 2. TheThe rescuer rescuer at the at the head head places places oneone hand hand under under each each of the of the patient's patient's 2. 2.The The rescuer rescuer at at thethe head head places places one one hand hand under under each each of of thethe patient's patient's shoulders shoulders shoulders shoulders

1. 1.Mula Mula sa sa Tripod/Straddle Tripod/Straddle o o 1. 1. Mula Mula sa sa Tripod/Straddle Tripod/Straddle o o nalatayong nalatayongposition positionng ng nalatayong nalatayong position positionng pasyente, pasyente, padaanain padaanain sa ng sa pasyente, pasyente,padaanain padaanainsa sa ilalim ilalim ng ng kilikili kilikili angang iyong iyong ilalim ilalim ngng kilikili kilikili ang ang iyong iyong kamay kamay at at hawakan hawakan angang kamay kamayat athawakan hawakanang ang m amgak g a kbai lbainl agn g b r ab sr o aso m a(kanang mgakgakbakamay ib l aikamay n l agn gsab sa rb a rsakalios o (kanang kali(kanang (kanangkamay kamaysa sakalikaliwang wangbraso, braso,kaliwang kaliwang wang wang braso, braso, kaliwang kaliwang kamay kamay sa sa kanang kanang braso) braso) kamay kamaysa sakanang kanangbraso) braso) ng ng pasyente. pasyente. ng pasyente. pasyente. 2. 2.Tng aT w aaw gai n g i n a nagn g k a k- a 2. 2. T aTwa awgai g n i n a nagn g k ak- a samahang samahang EMT EMT at bigyan at bigyan samahang samahang EMT EMT at at bigyan bigyan ng direksyon direksyon na na lumuhd lumuhd An Extremity Lift used tong carry a patient with no ngng direksyon direksyon nana lumuhd lumuhd n g n g n a n k a t k a a l t i a k l o i k d o d sor a saastair suspected spine or extremity injuries to a stretcher n gpasyente n g n ankat aaktat a tl ia kloi kdo d ito s aito sa pasyente hawakan hawakan pasyente pasyente at the at hawakan hawakan itoor ito from chair. It can be used to lift a patient from ground sa samagkabilang magkabilangalakalaksa sa magkabilang magkabilang alakalaka sitting position. alakan alakan o likod o likod ng ng tuhod. tuhod. alakan alakan o likod o likod ngng tuhod. tuhod. 3. 3.Sa Sa bilang bilang ng ng tatlo, tatlo, sabay sabay 3. 3.na Sa Sa bilang bilang ngng tatlo, tatlo, sabay sabay na tumayo. tumayo. Bigyan Bigyan ng ng nanatumayo. tumayo.Bigyan Bigyanngng direksyon direksyon angang kasama kasama at at direksyon direksyon ang ang kasama kasama at at pasyente pasyente na na kayo kayo ay ay ta- tapasyente pasyente na na kayo kayo ay ay ta1. One rescuer kneels at thetayo patient’s head and oneta-kneels tayo sa bilang sa bilang ng ng tatlo. tatlo. tayo tayo sa sa bilang bilang ngng tatlo. tatlo. 4. his 4.Habang Habang tumatayo tumatayo angang at the patient’s side by knees. 4. 4. Habang Habangtumatayo tumatayoang ang iyong iyong kasamahan, kasamahan, isabay isabay 2. The rescuer at the head places one hand under each of iyong iyongkasamahan, kasamahan,isabay isabay a n a g n g p a p g a s a g n s a d n a d l a l n g the patient’s shoulders a nagn g p apgasga snadnadl a l n gnn gg pasyente pasyente sa iyong sa iyong katwan katwan pasyente sahsa iyong upasyente pu apnagn g in hiyong d i ni katwan d ikatwan i t oi t o u puapnagn g h i hn idni d i i t oi t o masyadong masyadong mahirapan mahirapan sa sa masyadong masyadong mahirapan mahirapan sa sa pagtayo pagtayomula mulasa sapagpagpagtayo pagtayomula mulasa sapagpagkakaluhod. kakaluhod. kakaluhod. kakaluhod. 5. 5.Bigyan Bigyan ng ng direksyon direksyon angang 5. 5. Bigyan Bigyan ngng direksyon direksyon ang kasama na na ihakbang ihakbang 1. Mula sa Tripod/Straddle okasama nakatayong position ngang pasyente, kasama kasama nana ihakbang ihakbang muna muna ang ang kanyang kanyang padaanin sa ilalim ng kili-kili ang iyong kamay at hawakan ang muna muna ang ang kanyang kanyang kanang kanang paapaa habang habang ikaw ikaw magkabilang braso (kanang kamay sapaa kaliwang braso, kanang kanang paa habang habang ikaw ikaw ay ay ihahakbang ihahakbang angang kaka- kaliwang aypasyente. ayihahakbang ihahakbangang angka-kakamay sa kanang braso) ng liwa. liwa. liwa. liwa. 2. Tawagin ang kasamahang EMT at na bigyan ng direksyon 6. 6.Sabay Sabay namaglakad maglakad sa sa na 6. 6. Sabay Sabaynanamaglakad maglakadsa sa bilang ng ng tatlo. tatlo. lumuhod nang nakatalikodbilang sabilang pasyente at hawakan ito sa bilang ngng tatlo. tatlo.

Extremity Lift (no suspected extremity injuries)

Follow these steps:

MGA HAKBANG:

magkabilang alak-alakan o likod ng tuhod. 3. Sa bilang na tatlo, sabay na tumayo. Bigyan ng direksyon ang kasama at pasyente na kayo ay tatayo sa bilang na tatlo. 4. Habang tumatayo ang iyong kasamahan, isabay ang pagsandal ng pasyente sa iyong katawan upang hindi ito masyadong mahirapan sa pagtayo mula sa pagkakaluhod. 5. Bigyan ng direksyon ang kasama na ihakbang muna ang kanyang kanang paa habang ikaw ay ihahakbang ang kaliwa. 6. Sabay na maglakad sa bilang na tatlo.

Limmer Limmer (Brady) (Brady) ²² Limmer ²² Limmer (Brady) (Brady) Pollack, Pollack, (AAOS) (AAOS) Limmer (Brady) (Brady) ³³²Pollack, ³³² Limmer Pollack, (AAOS) (AAOS) NHTSA NHTSA Pollack, ³⁴⁴ Pollack, (AAOS) (AAOS) ⁴⁴³ NHTSA NHTSA ⁴ NHTSA ⁴ NHTSA

Transfer of supine patient from bed to stretcher Direct carry

A direct carry is performed to move a patient with no suspected spine injury from a bed or from a bedlevel position to a stretcher

Follow these steps:

1. Position cot perpendicular to bed with head end of cot at foot of bed. 2. Prepare cot by unbuckling straps and removing other items. 3. Both rescuers stand between bed and stretcher, facing patient. 4. First rescuer slides arm under patient’s neck and cups patient’s shoulder. 5. Second rescuer slides hand under hip and lifts slightly. 6. First rescuer slides other arm under patient’s back. 7. Second rescuer places arms underneath hips and calves. 8. Rescuers slide patient to edge of bed. 9. Patient is lifted toward the rescuers’ chests. 10. Rescuers rotate and place patient gently onto cot.

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PREHOSPITAL EMERGENCY CARE

153

UNIT 1 DAY 16 UNIT DAY 6

FOUNDATION OF EMT PRACTICE MGA MGA HAKBANG: HAKBANG: UNIT 11 UNIT LIFTING AND CARRYING PATIENTS Day 6 FOUNDATION OF 1. 1.Mula Mula sa Straddle/Tripod sa Straddle/Tripod o oEMT PRACTICE DAY 66 DAY nakatayong nakatayong posisyon, posisyon, hawakan hawakan angang braso braso ngWALK ng ASSIST TO pasyente pasyente at at dahan-dahan dahan-dahan Draw-sheet method Follow these steps: UNIT 1 MGH MGA ASSIST TO WALK itong iangat iangat habang habang ang ang1. Loosen bottom sheet of bed. FOUNDATION OF EMT Draw-sheet method is one ofitong two DAY 6 isang isang kamay kamay ay ay nakahanakaha-

methods (along with the direct carry method) 2. Position cot next to bed. wak wak sa sa sinturera sinturera o bayo baythat is performed during transfers between 3. Prepare cot: Adjust height, lower rails, unbuckle wang wang ng ng pasyente. pasyente. hospitals and nursing homes,2.or2.when a ang Ilusot Ilusot ang uloulo sa sa ilalim ilalim ng ng straps. patient must be moved from a bed at home kamay kamay ng ngpasyente pasyenteat at4. Reach across cot and grasp sheet firmly at pa1 A HAKBANG: to a stretcher. It is used for aUNIT ihakbang ihakbang isang paapaa tient’s head, chest, hips and knees. UNIT 1 noangangisang patient with sa 6 sa gilid gilid upang upang humanda humanda5. Slide patient gently onto cot. A HAKBANG: suspected spine injury. DAY DAY 6

ASSIST TO WALK

FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE

Mula sa Straddle/Tripod sa paglakad sa paglakad NDATION OF oEMT PRACTICE nakatayong posisyon, 3. 3.Bigyan Bigyan ng ng direksyon direksyon angang

Mula sa Straddle/Tripod o hawakan ang posisyon, braso ng pasyente pasyente na na kayo kayo ay ay la- lanakatayong pasyente dahan-dahan lakad lakad ng ng sabay sabay habang habang hawakan atang braso ng itong iangat habang ang ikaw ikaway aynakaalalay nakaalalaysa sa pasyente at dahan-dahan isang kamay habang ay nakahakanya kanya sa bilang sa bilang ng ng tatlo. tatlo. itong iangat ang 1. Assist to Walk wak sinturera o bayisang sakamay ay nakaha2. Assist to Walk with Assistance wang ng sinturera pasyente.o bayTANDAAN: TANDAAN: wak sa 3. Firefighter’s Carry Ilusot ulo sa ilalim ng wang ang ng pasyente. ngulopasyente at Ilusot ang sa ilalim ng 1. with 1.Iangat Iangat lamang lamang angang kamay kamay 4. Firefighter’s Carry Assistance Tkamay 11 kamay ngang pasyente at ihakbang isang paa at at braso braso ng ng pasyente pasyente sa sa 5. Lover’s Carry ang isang paa HAKBANG: humanda kung kung hanggang hanggang saan saan lang lang Ysaihakbang 6gilid upang MGA 6 MGA HAKBANG: 6. Pack Strap Carry sa paglakad gilid upang humanda sa angang kaya kaya (lebel (lebel ng ng kankan7.Mula Piggyback Carry yang sa paglakad Bigyan ng direksyon 1. ang yang kamay kamay at at balikat) balikat) sa Straddle/Tripod o 1. Mula sa Straddle/Tripod o Bigyan ngna direksyon pasyente kayo ayang la-nakatayong posisyon, upang upangmaiwasan maiwasanangang pasyente kayohabang ay lanakatayong posisyon, lakad ng na sabay dagdag dagdag na na kondisyon. kondisyon. hawakan ang braso ng hawakan ang braso ng lakad ay ng sabay habang ikaw nakaalalay sapasyente at dahan-dahan 2. 2. Lagging Lagging hawakan hawakan angang pasyente at dahan-dahan ikaw sa aybilang nakaalalay kanya ng tatlo.sa baywang baywang o sinturera o sinturera upan upan iangat habang ang itong iangat habang ang kanya sa bilang ng tatlo. itong hndi hndimabuwal mabuwalo oma-maisang isangkamay kamayayaynakahanakahaNDAAN: tumba tumba angang pasyente, pasyente, wak waksa sasinturera sinturerao obaybayNDAAN: 3. 3.Suportahan Suportahan ito ito sa sa paglapaglawang ngng pasyente. wang pasyente. Iangat lamang ang kamay lakad. lakad. 2. 2. Ilusot ang uloulo sa sa ilalim ng Iangat lamang ang kamay Ilusot ang ilalim ng at pasyente sa sakamay ng pasyente at at braso braso ng ng pasyente kamay ng pasyente at kung hanggang saan lang kung hanggang saan lang ihakbang ihakbangang angisang isangpaa paa ang kaya (lebel ng kansa sagilid upang humanda ang kaya (lebel ng kangilid upang humanda oyang kamay at balikat) paglakad yang kamay at balikat) sa sa paglakad n,upang angBigyan ng direksyon ang upang maiwasan maiwasan 3. ang 3. Bigyan ng direksyon ang gdagdag na kondisyon. dagdag na kondisyon. pasyente pasyentenanakayo kayoayayla- lanLagging ang Lagging hawakan hawakan ang lakadngngsabay sabayhabang habang gbaywang o sinturera upanlakad baywang sinturera upan ikaw ikawayaynakaalalay nakaalalaysa sa ahndi ma-kanya sa bilang ng tatlo. hndi mabuwal mabuwal oo makanya sa bilang ng tatlo. ytumba pasyente, tumba ang pasyente, Suportahan ito sa Suportahan sa paglapaglaTANDAAN: TANDAAN: glakad. lakad. at 1. 1. Iangat lamang ang kamay a Iangat lamang ang kamay at atbraso a brasongngpasyente pasyentesa sa kung hanggang saan lang kung hanggang saan lang ang g angkaya kaya(lebel (lebelngngkankanyang ayangkamay kamayat atbalikat) balikat) upang g upang maiwasan maiwasan ang ang dagdag nana kondisyon. a dagdag kondisyon. 2. 2. Lagging Lagging hawakan hawakan ang ang baywang o sinturera upan baywang o sinturera upan hndi 1. Mula Straddle/Tripod o nakatayong hndisamabuwal mabuwal o o mamatumba ang pasyente, posisyon, hawakan ang braso ng tumba ang pasyente, 3. 3.pasyente Suportahan itoitosa sapaglay Suportahan pagla-itong iangat at dahan-dahan lakad. a lakad.ang isang kamay ay nakahawak habang g sa sinturera o baywang ng pasyente. n2. Ilusot ang ulo sa ilalim ng kamay ng t) g pasyente at ihakbang ang isang paa sa

TO ASSIST TOWALK WALK Other Methods of Patient Transfer (NoASSIST Spine Injury ) ASSIST TO WALK MGA HAKBANG: 1.

FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE FOUNDATION ASSISTTO TOWALK WALK ASSIST

ASSIST TO WALK

MGA HAKBANG:

² Limmer (Brady) gilid upang humanda sa paglakad. ³ Pollack, (AAOS) Limmer (Brady) 3. Bigyan⁴ ³²NHTSA ng direksyon ang pasyente na Pollack, (AAOS) kayo ay⁴ NHTSA lalakad nang sabay habang ikaw ay naka-alalay sa kanya sa bilang ng tatlo.

g n a-

154

LIFELINE

PREHOSPITAL EMERGENCY CARE

MGA HAKBANG:

Mula sa Straddle/Tripod o nakatayong posisyon, 1. Mula straddle/Tripod o hawakan ang braso ng nakatayong posisyon, pasyente at dahan-dahan iangat itong iangat habang ang ang kabilang kang pasyente at iabot isang kamay ay may nakahawak sa sinturerasao iyong bay- kasama, pareho wang ng pasyente.ninyong hawakan ang Ilusot ang ulo sa ilalim ng o baywang ng sinturero kamay ng pasyente at pasyente upang hndi ito ihakbang ang isang paa matumba. sa gilid upang humanda sa paglakad 2. Sabay na gawein: Ilusot MGA HAKBANG: HAKBANG: angang ulo sa ilalim ng kamay MGA Bigyan ng direksyon pasyente na kayongaypasyente laat ihakbang Mulastraddle/Tripod straddle/Tripodo o lakad ng sabay ang habang isang paa sa gilid 1. 1.Mula ikaw ay nakaalalay sa nakatayongposisyon, posisyon, nakatayong upang humanda sa kanya sa bilang ng tatlo. iangat kabilang iangat angang kabilang kaka-

paglakad Bigyan ng direksyon ang kasama mo at ang UNIT pasyente na kayo ay Iangat lamang ang kamay DAY at braso ng pasyente sa maglalakad na sa bilang kung hanggang saan lang ng tatlo.

TANDAAN: 1.

1. 1. M n ia m sa ni si pa m 2. 2. Sa an ng an u pa 3. 3. Bi ka pa m ng

pasyente at iabot maymay ng ng pasyente at iabot sa iyong kasama, pareho sa iyong kasama, pareho 1ninyong ninyonghawakan hawakanangang sinturero o baywang 6sinturero o baywang ng ng pasyente upang hndi pasyente upang hndi ito ito matumba. matumba. Sabay gawein: Ilusot 2. 2.Sabay na na gawein: Ilusot sa ilalim kamay angang ulo ulo sa ilalim ng ng kamay M pasyente at ihakbang MG ng ng pasyente at ihakbang isang gilid angang isang paapaa sa sa gilid upanghumanda humandasa sa 1. 1 upang paglakad paglakad Bigyan direksyon 3. 3.Bigyan ng ng direksyon angang kasamamomoat atangang kasama pasyentena nakayo kayoay ay pasyente maglalakad bilang maglalakad na na sa sa bilang ng tatlo. ng tatlo.

ang kaya (lebel ng kanyang kamay at balikat) upang maiwasan ang dagdag na kondisyon. Lagging hawakan ang baywang o sinturera upan hndi mabuwal o matumba ang pasyente, Suportahan ito sa paglalakad.

FOUNDA

FIREFIG

2. 2

TANDAAN:

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

1. Iangat lamang angMGA kamay at braso ng HAKBANG: pasyente sa kung hanggang saan lang mula sa pagkakahiga ng ang kaya (lebel ng 1.kanyang kamay at ang pasyente, pagdikitin balikat) upang maiwasan angnitong dagdagpaa an dalawa marahang tapakan upang na kondisyon. hndi ito gumalaw o malis 2. Laging hawakan ang baywang o(Brady) Limmerhabang sa pwesto, kinu³ Pollack, (AAOS) ⁴ NHTSA sinturera upan hindi mabuwal odalawang kakuha ang may na nakahawak sa matumba ang pasyente, magkabilang braso. 3. Suportahan ito sa 2. paglalakad. Sa isang mabilis na kilos, ²

hatakin patayo ang pasyente, ilusot ang isang kamay sa pagitan ng dalawang hita nito habang inilalagay ang katawan sa iyong likod at balikat. Kunin ang isang kamay at ha waka n ng iy ong kanilang kamay upang iyong mahawakang mabuti ang kanyang paa at kamay habang ikaw ay tumatayo at humanda na

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

3. 3

MGA MGA HAKBANG: HAKBANG:

1. 1. Mula Mulastraddle/Tripod straddle/Tripodo o nakatayong nakatayong posisyon, posisyon, iangat iangatang angkabilang kabilangka-kamay may ngng pasyente pasyente at at iabot iabot sa sa iyong iyong kasama, kasama, pareho pareho ninyong ninyong hawakan hawakan ang ang sinturero sintureroo obaywang baywangngng pasyente pasyenteupang upanghndi hndiitoito matumba. matumba. UNIT UNIT 1 1 2. 2. Sabay Sabaynanagawein: gawein:Ilusot Ilusot DAY DAY 6 6 ang ang ulo ulo sa sa ilalim ilalim ng ng kamay kamay GA HAKBANG: HAKBANG: ngng pasyente pasyente at at ihakbang ihakbang MGA HAKBANG: ang angisang isangpaa paasa sagilid gilid Mulastraddle/Tripod straddle/Tripodo o Mula upang upang humanda humanda sa sa 1. Mula straddle/Tripod o nakatayong posisyon, posisyon, akatayong paglakad paglakad nakatayong posisyon, iangatang angkabilang kabilangka-kaangat 3. 3. Bigyan Bigyan ngng direksyon direksyon ang ang iangat ang kabilang kamay pasyente iabot may ngng pasyente at at iabot kasama kasama momo at at ang ang may ng pasyente at iabot iyong kasama, pareho a sa iyong kasama, pareho pasyente pasyente nana kayo kayo ay ay sa iyong kasama, pareho ninyong hawakan hawakan ang ang inyong maglalakad maglalakadnanasa sabilang bilang ninyong hawakan ang sintureroo obaywang baywangngng inturero ngng tatlo. tatlo. sinturero o baywang ng pasyenteupang upanghndi hndiitoito asyente pasyente upang hndi ito matumba. matumba. matumba. Sabaynanagawein: gawein:Ilusot Ilusot abay 2. Sabay na gawein: Ilusot ng uloulo sa sa ilalim ngng kamay ang ilalim kamay ang ulo sa ilalim ng kamay MGA HAKBANG: MGA HAKBANG: gng pasyente at at ihakbang pasyente ihakbang ng pasyente at ihakbang ng gilid angisang isangpaa paasa sa gilid ang isang paa sa gilid UNIT UNIT 1 Mula straddle/Tripod straddle/Tripod o o 1. 1.1Mula pang upang humanda humanda sa sa upang humanda sa nakatayong posisyon, nakatayong posisyon, DAY DAY6iangat 6iangatang aglakad paglakad paglakad angkabilang kabilangka-kaigyan ngng direksyon ang Bigyan direksyon ang may 3. Bigyan ng direksyon ang mayngngpasyente pasyenteatatiabot iabot asama kasama momo at at ang ang sasaiyong kasama mo at ang iyongkasama, kasama,pareho pareho asyente pasyente nana kayo kayo ay ay ninyong pasyente na kayo ay ninyong hawakan hawakan ang ang maglalakad na sa bilang maglalakad maglalakadnanasa sabilang bilang sinturero sintureroo obaywang baywangngng MGA MGA HAKBANG: HAKBANG: ng tatlo. gng tatlo. tatlo. pasyenteupang upanghndi hndiitoito pasyente

FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE

ASSIST WALK WITH ASSISTANCE ASSIST TOTOWALK WITH ASSISTANCE

ASSIST TO WALK WITH ASSISTANCE T PRACTICE

FOUNDATION FOUNDATION OF OF EMT EMT PRACTICE PRACTICE FIREFIGHTER’S FIREFIGHTER’S CARRY CARRY

FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE FIREFIGHTER’S FIREFIGHTER’SCARRY CARRY

matumba. matumba. 1. 1.mula mula sa pagkakahiga sa pagkakahiga ng ng Sabaynanagawein: gawein:Ilusot Ilusot 2. 2. Sabay pasyente, pasyente, pagdikitin pagdikitin angang ang ulo sa ilalim ng kamay ang ulo sa ilalim ng kamay dalawa dalawa nitong nitong paapaa an an ² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) pasyenteat atihakbang ihakbang ngngpasyente marahang marahang tapakan tapakan upang upang ⁴ NHTSA ⁴ NHTSA angisang isangpaa paasasagilid gilid hndihndi ito gumalaw ito gumalaw o malis o malis ang sa pwesto, sa pwesto, habang habang kinukinuupang humanda humanda sasa upang 2.dalawang Sabay na Ilusot ang ulo sa ilalim ng angang dalawang ka-gawin: kapaglakad Mula Straddle/Tripod o nakatayong kuhakuha paglakad maymay na na nakahawak nakahawak sa pasyente sa Bigyanang direksyonang ang kamay ng at ihakbang ang isang 3. 3. iangat Bigyan ngngdireksyon posisyon, kabilang kamay magkabilang magkabilang braso. braso. kasama mo mo atat ang ang kasama paa sana gilid upang humanda sa paglakad. ng pasyente at iabot sa iyong kasama. 2. 2. Sa isang Sa isang mabilis mabilis na kilos, kilos, pasyente nana kayo kayo ayay pasyente 3.patayo Bigyan ngang direksyon ang kasama mo at ang hatakin hatakin patayoang Pareho ninyong hawakan ang sinturero maglalakad bilang maglalakad nanasasa bilang pasyente, ilusot ilusot angang isang isang pasyente na kayo ay maglalakad na sa bilang ng tatlo. o baywangngng pasyente upang hndi itopasyente, tatlo.

MGA HAKBANG:

ATION OF EMT PRACTICE matumba.

GHTER’S GA MGA HAKBANG: HAKBANG: CARRY FIREFIGHTER’S 1. mula mulasasapagkakahiga pagkakahigangng CARRY

² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

pasyente, pasyente,pagdikitin pagdikitinang ang dalawa dalawa nitong nitong paa paa anan marahang marahang tapakan tapakan upang upang hndi hndiitoitogumalaw gumalawo omalis malis sasapwesto, pwesto,habang habangkinukinukuha kuhaang angdalawang dalawangka-kamay maynananakahawak nakahawaksasa magkabilang magkabilang braso. braso. 2. SaSaisang isangmabilis mabilisnanakilos, kilos, hatakin hatakin patayo patayo ang ang pasyente, pasyente, ilusot ilusot ang ang isang isang kamay kamay sasa pagitan pagitan ngng daladalawang wanghita hitanito nitohabang habang inilalagay inilalagay ang ang katawan katawan sasa iyong iyong likod likod atat balikat. balikat. 3. Kunin Kunin ang ang isang isang kamay kamay atat haha waka waka n n ngng iy iy ong ong kanilang kanilang kamay kamay upang upang iyong iyongmahawakang mahawakangmamabuti butiang angkanyang kanyangpaa paaatat kamay kamayhabang habangikaw ikawayay tumatayo tumatayoatathumanda na pagkakahiga 1.humanda Mulanasa sasa paglalakad. paglalakad.

kamay kamay sa pagitan sa pagitan dalang dalang ng tatlo. wang wang hitahita nitonito habang habang inilalagay inilalagay angang katawan katawan sa sa iyong iyong likodlikod at balikat. at balikat. 3. 3.Kunin Kunin angang isang isang kamay kamay at at ha waka ha waka n nng ngiy ong iy ong kanilang kanilang kamay kamay upang upang iyong iyong mahawakang mahawakang ma-mabutibuti angang kanyang kanyang paapaa at at kamay kamay habang habang ikawikaw ay ay tumatayo tumatayo at humanda at humanda na na sa paglalakad. sa paglalakad.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

MGA HAKBANG:

² Limmer (Brady) ³ Pollack, (AAOS) ² Limmer (Brady) ⁴ NHTSA ³ Pollack, (AAOS) ⁴ NHTSA

ng pasyente, pagdikitin ang dalawa nitong paa at marahang tapakan upang hindi ito gumalaw o malis sa pwesto, habang kinukuha ang dalawang kamay na nakahawak sa magkabilang braso. 2. Sa isang mabilis na kilos, hatakin patayo ang pasyente, ilusot ang isang kamay sa pagitan ng dalawang hita nito

habang inilalagay ang katawan sa iyong likod at balikat. ³ Pollack, ³ Pollack, (AAOS)(AAOS) ⁴ NHTSA ⁴Kunin NHTSA 3. ang isang kamay at hawakan ng iyong kabilang kamay upang iyong mahawakang mabuti ang kanyang paa at kamay habang ikaw ay tumatayo at humanda na sa paglalakad. ² Limmer ² Limmer (Brady)(Brady)

LIFELINE

PREHOSPITAL EMERGENCY CARE

155

UNIT UNIT 1111 UNIT UNIT UNIT UNIT DAY DAY 66161 DAY DAY 6 DAY DAY66

FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE FOUNDATION FOUNDATION OF OF EMT EMT PRACTICE PRACTICE FOUNDATION FOUNDATION OF OF EMT EMT PRACTICE PRACTICE

Day 6

LIFTING AND CARRYING PATIENTS FIREFIGHTER’S FIREFIGHTER’S CARRY CARRY WITH WITH ASSISTANCE ASSISTANCE FIREFIGHTER’S FIREFIGHTER’S CARRY WITH WITH ASSISTANCE ASSISTANCE FIREFIGHTER’S FIREFIGHTER’SCARRY CARRY CARRY WITH WITH ASSISTANCE ASSISTANCE

MGA MGA HAKBANG: HAKBANG: MGA MGAHAKBANG: HAKBANG: MGA MGAHAKBANG: HAKBANG: 1. 1. 1.1. Mula Mula sa sa Tripod/Straddle sa Tripod/Straddle o ooo Mula Mula saTripod/Straddle Tripod/Straddle 1.1. Mula Mula sasaTripod/Straddle Tripod/Straddle oo MGA HAKBANG: nakatayong nakatayong posisyon posisyon ngng ng nakatayong nakatayong posisyon posisyon ng nakatayong nakatayong posisyon posisyon ng ng pasyente pasyente , kunin , kunin ang ang pasyente pasyente , , kunin kunin ang ang pasyente pasyente ,Tripod/Straddle , ng kunin kunin ang ang isang isang kamay kamay pasyente 1.isang Mula sang isang kamay kamay ngpasyente ngpasyente pasyente isang isang kamay kamay ng ngposisyon pasyente pasyente habang habang inihahakbang inihahakbang o nakatayong ng habang habang inihahakbang inihahakbang habang habang inihahakbang inihahakbang ang ang paang paang nasa nasa likuran likuran pasyente , kunin ang isang ang angpaang paangnasa nasalikuran likuran ang ang paang paang nasa nasa likuran likuran papunta papunta sa sa sa harapan harapan ng ng kamay ng pasyente habang papunta papunta saharapan harapan ng ng papunta papunta sasa harapan harapan ng ng nasa pasyente.. pasyente.. Isunod Isunod ang ang isa isa inihahakbang ang paang pasyente.. pasyente.. Isunod Isunod ang ang isa isa pasyente.. pasyente.. Isunod Isunod ang ang isa isa pang pang paa paa upang upang makamakalikuran papunta sa harapan ng pang pang paa paa upang upang makamakapang pang paa paa upang upang makamakabuo buo ng ng isang isang matibay matibay na na pasyente.. Isunod ang isa pang buo buo ng ngisang isang matibay matibay na na buo buong ngisang isangmatibay matibayna na posisyon. posisyon. posisyon. posisyon. paa upang makabuo ng isang posisyon. posisyon. 2. 2. 2.2. Ilusot Ilusot ang ang isang isang kamay kamay sa Ilusot Ilusot ang angisang isang kamay kamaysasa sa matibay na posisyon. 2.2. Ilusot Ilusot ang ang isang isang kamay kamay sasa pagitan pagitan ng ng dalawang dalawang paa paa pagitan pagitan ng ngdalawang dalawang paa paa 2. Ilusot ang isang kamay pagitan pagitan ng ng dalawang dalawang paa paa ngng ng pasyente pasyente habang habang nagnagngpasyente pasyente habang habang nagnagpagitan ng dalawang ngsa pasyente habang habang nagnagp apng pa tpaa upasyente ataltu otng ulu no lo pap ap a p lgpasyente n onn gggs as sasahabang ak ak-kaka-a-ppaappaat ut ul ol onngg s as a k kaa- samahang samahang EMT EMT nana na iangat iangat samahang samahang EMT EMT na iangat nagpapatulong saiangat kasamahang samahang samahang EMT EMTna na iangat iangat itoito ito papunta papunta saiangat iyong sa iyong likod likod itopapunta papunta sa saiyong iyong likod likod EMT na ito papunta ito itopapunta papuntasasaiyong iyonglikod likod sa at at balikat. atatbalikat. balikat. balikat. iyong likod at balikat. atatbalikat. balikat. bilang bilang ngtatlo, tatlo, tumayo tumayo 3. 3. 3.3. Sa Sa bilang Sa bilang ngng ng tatlo, tatlo, tumayo tumayo 3.Sa Sa bilang tatlo, tumayo 3.3. Sa Sabilang bilang ng ngna tatlo, tatlo, tumayo tumayo habang habang nakaalalay nakaalalay ang ang habang habang nakaalalay nakaalalay ang ang habangnakaalalay nakaalalay ang habang habang nakaalalay ang ang kasamahang kasamahang EMT EMT sa inkasamahang kasamahang EMT EMT sasa sa ininkasamahang kasamahang EMT EMT sa sa ininkasamahang EMT saininyong yong yong dalawa dalawa ng ngpasyente. pasyente. yong yong dalawa dalawa ng ng pasyente. pasyente. yong yong dalawa dalawa ngpasyente. pasyente. dalawa ng ng pasyente. Ang Ang kasamahang kasamahang EMT EMT ay 4. 4. 4.4. Ang Ang kasamahang kasamahang EMT EMT ayay ay 4. 4. Ang Ang kasamahang kasamahang EMT EMT ay ayay 4. Ang kasamahang EMT dapat dapat pumosisyon pumosisyon sa dapat dapat pumosisyon pumosisyon sasa sa dapat dapat pumosisyon pumosisyon sa sa dapat pumosisyon sa harapan harapan harapan ninyo ninyo upang upang harapan harapan ninyo ninyo upang upang harapan harapan ninyo ninyo upang upang ninyo upang magsilbing magsilbing magsilbing taga taga hawi hawi o magsilbing magsilbing taga taga hawi hawi o oooo magsilbing magsilbing taga taga hawi hawi tagahawi o gabay sa inyong gabay gabay sa sa inyon inyon gpaglagpaglagabay gabay sa sa sa inyon inyon gpaglagpaglagabay gabay sa inyon inyon gpaglapaglalakad lalo sagpaglamatataong lakad lakad lalo lalo sa matataong matataong lakad lakad lalo lalo sa sa sa matataong matataong lakad lakad lalo lalo sa sa matataong matataong lugar. lugar. lugar. lugar. lugar. lugar. lugar. 5.Ikapit Ikapit ang kamay na hindi Ikapit ang ang kamay kamay na hndi hndi 5. 5. Ikapit Ikapit ang ang kamay kamay nana na hndi hndi 5.5. 5. Ikapit Ikapit ang ang kamay kamay na na hndi hndi nakahawak sa pasyente nakahawak nakahawak sa pasyente sasa nakahawak nakahawak sasa pasyente sa pasyente sasa sa nakahawak nakahawak sa sapasyente pasyente pasyente sa sa balikat ng iyong kasamahan balikat balikat ng ng iyong iyong kakabalikat balikat ng iyong kabalikat balikatngng ngiyong iyong iyongka-kakakung nasaan angang direksyon samaha, samaha, kung kung nasaan nasaan ang ang samaha, samaha, kung kung nasaan nasaan ang samaha, samaha, kung kung nasaan nasaan ang ang direksyon direksyon ng ulo ulong ng ng ng ulo ng ngng pasyente ikapit direksyon direksyon ng ulo ng direksyon direksyon ng ngulo ulo ulo ng ng pasyente pasyente ikapit ikapit ang ang kamay kamay ang kamay sa balikat ng pasyente pasyente ikapit ikapit ang ang kamay kamay pasyente pasyente ikapit ikapit ang ang kamay kamay sa balikat ng kasamahan kasamahan kasamahan na taliwas sa sa sabalikat balikat balikat ng ng kasamahan kasamahan sa sa balikat balikat ngng ng kasamahan kasamahan na taliwas sa direksyon na direksyon na ito, upang na nataliwas taliwas taliwas sa sadireksyon direksyon direksyon na na nana taliwas taliwas sa sa direksyon sa direksyon nana na ito, ito, upang upang magsilbing magsilbing magsilbing proteksyon din ito, upang upangmagsilbing magsilbing magsilbing ito,ito, ito, upang upang magsilbing proteksyon proteksyon din din ang ang espasespasang espasyong mabibigay proteksyon proteksyon din ang ang espasespas- ng proteksyon proteksyon dindin din ang ang espasespasyong yong mabibigay mabibigay ng ngnaglalakad kakakasamahan habang yong yong mabibigay mabibigay ng ng kayong yong mabibigay mabibigay ng ng ka-kakasamahan samahan habang habang naglanaglakayo habang patungo sa inyong samahan samahan habang habang naglanaglasamahan samahan habang naglanaglalakad lakad kayo kayo patungo sasa sa lakad lakad kayo kayo patungo patungo istasyon o patungo ambulansya. lakad lakad kayo kayo patungo patungo sa sa sa inyong inyong istasyon istasyon ooo oambuambuinyong inyong istasyon istasyon ambuambuinyong inyong istasyon istasyon o ambuo ambulansya. lansya. lansya. lansya. lansya. lansya.

156

LIFELINE

PREHOSPITAL EMERGENCY CARE

MGA HAKBANG: MGA HAKBANG:

FIREFIGHTER’S CARRY WITH ASSISTANCE

² Limmer ² Limmer (Brady) (Brady) ² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ³ Pollack, Pollack, (AAOS) (AAOS) ² Limmer ²³⁴Limmer (Brady) (Brady) ⁴ NHTSA NHTSA ⁴ ³NHTSA ⁴ Pollack, NHTSA ³ Pollack, (AAOS) (AAOS)

⁴ NHTSA ⁴ NHTSA

U UN D DA

MulasasaTripos/ Tripos/ Strad 1.1. Mula Straddl nakatayong posisy posis nakatayong hawakan hawakanang angbraso bras kamay kamayngngpasyente pasyente bang kamay bangang angisang isang kam nakaalalay nakaalalay sasa kabila kab bahagi bahagi habang habang haw h ang baywang o sinture ang baywang o sintu 2.2. Dahan-dahang Dahan-dahang iang ia hanggang hanggangsasakung kung lang kaya ng pasyente lang kaya ng UNIT pasyen UN lebel lebelngngkanyang kanyangkam k DAY DA ang kanyang braso. ang kanyang braso. 3.3. Ipaalam Ipaalamsasapasyente pasyent ikaw ikawayayluluhod luluhodhaba ha sya ay uupo sa iyong h sya ay uupo sa iyong sasa bilang ngng tatlo. bilang tatlo. 4.4. SaSaiyong iyongpagluhod, pagluhod,si raduhin raduhinnanaitoitoayayn 90* na angulo upa 90* na saangulo u 8. 8. Humanda Humanda samaayos pagtayo pagta makaupo ngng a makaupo maayos ilapiit ilapiit ang ang katawan katawan n pasyente atat masup pasyente mas pasyente pasyentesasaiyong iyongkata ka tahan mo kanya tahan moang ang kan wan wan upang upang mas masmada mad bigat. Siguraduhin bigat. Siguraduhindin d itong itong buhatin, buhatin, ang iyong likod ay naka ang ng iyong likod ayan na 9. 9. Bigyan Bigyan ngdireksyon direksyon a retcho. retcho. pasyente pasyentenanaikaw ikawayayta 5.5. habang nakaluhod kuk habang nakaluhod tayo tayosasabilang bilangngng tatl ta UN U ang kamay ngng pasyente ang kamay pasyen kaya kaya sya sya ayaykumapit kumapit n ipatong sasa iyong balika DA ipatong iyong balik D mabuti. mabuti. ang angisang isangkamay kamay nia 10. 10.Marahang Marahang iangat iangatnito an ipahawak mabuti sa ipahawak mabuti sa pasyente pasyentesasa“power “powersqua sq may nana nasa balikat mo may nasa balikat Position” Position” bago bago tumayo. tumayo. Itm 6.6.ayAng kamay naka kamayna na na ayAng magbibigay magbibigay sayo sayo n porta sa baywang ay ili porta sa kakayanin baywang ay ideya ideya kung kung kakayanin m balikat nggpasyenten pasyente. basa basa ang ang iyon iyon gpasyente balikat ng pasyente 7.7.buhatin Ang kamay nam buhatin o ohindi. hindi. Kung Kung s Angisang isang kamay na ay saay ilalim posisyong posisyong itoito kinay kina ay ilagay ilagay saay ilalim dalawa nitong paa o mo mo ang angpasyente, pasyente, maa ma dalawa nitong paa alak-lakan. kamay ka ng ng tumayo tumayo atat pumunt pumu may alak-lakan. sasa istasyon istasyon o ambulansya o ambulansy 11.11.(ang (anghakbang hakbangnanaitoitoa ginagawa ginagawa ngng mabilis mabilis hind hi nangangahulugan nangangahulugan n magtatagal magtatagalkakasasa“powe “pow squat squat posisyon”) posisyon”)

hawakan hawakan ang ang brasobraso at at kamay kamay ng pasyente ng pasyente ha- habangbang ang ang isangisang kamay kamay ay ay nakaalalay nakaalalay sa sa kabilang kabilang bahagi bahagi habang habang hawak hawak ang baywang ang baywang o sinturera. o sinturera. 2. Dahan-dahang 2. Dahan-dahang iangat iangat hanggang hanggang sa kung sa kung san san lang lang kaya kaya ng pasyente ng pasyente o o lebellebel ng kanyang ng kanyang kamay kamay UNIT UNIT 11 ang kanyang ang kanyang braso. braso. DAY DAY 3. Ipaalam 3. Ipaalam sa pasyente sa pasyente na 6 na6 ikawikaw ay luluhod ay luluhod habang habang sya ay syauupo ay uupo sa iyong sa iyong hita hita sa bilang sa bilang ng tatlo. ng tatlo. 4. Sa 4. iyong Sa iyong pagluhod, pagluhod, sigu-siguraduhin raduhin na ito na ay ito nasa ay nasa 90* 90* na na angulo angulo upang upang makaupo makaupo ng maayos ng maayos ang ang 8. 8.Humanda Humandasa sapagtayo, pagtayo, pasyente pasyente at at masupormasuporilapiit ilapiitangangkatawan katawanng ng tahan tahan mo mo ang ang kanyang kanyang pasyente pasyente sa sa iyong iyong katakatabigat.bigat. Siguraduhin Siguraduhin din na din na wan wan upang upang masmas madali madali ang iyong ang iyong likod likod ay nakadiay nakadiitong itong buhatin, buhatin, retcho. retcho. 9. 9. Bigyan Bigyan ng ng direksyon direksyon angang 5. habang 5.pasyente habang nakaluhod kunin kunin pasyente nanakaluhod na ikaw ikaw ay ay tataang kamay ang ngbilang pasyente ngng pasyente attatloat tayo tayo sa kamay sa bilang ng tatlo ipatong ipatong sa iyong sa iyong balikat balikat at kaya kaya syasya ay ay kumapit kumapit ng ngat UNIT ang ang isangisang kamay kamay nito UNIT nito ay 1ay 1 mabuti. mabuti. ipahawak ipahawak mabuti mabuti sa kasaang DAY DAY 6ka- 6 10.10. Marahang Marahangiangat iangat ang may may na nasa na balikat balikat mo. mo. pasyente pasyente sanasa “power sa “power squat squat 6. Ang 6.Position” Ang kamay kamay natumayo. nakasuna nakasuPosition” bago bago tumayo. Ito Ito porta porta samagbibigay baywang sa baywang ay sayo ilipat ay ay ay magbibigay sayo ngilipat ng saideya balikat sa balikat ng pasyente. ng pasyente. ideya kung kung kakayanin kakayanin momo 7. Ang 7.ba ba Ang isang isang kamay kamay naman naman ang ang iyon iyon gpasyenteng gpasyenteng ay ilagay ay ilagay sa ilalim saKung ilalim ng ng buhatin buhatin o hindi. o hindi. Kung sa sa dalawa dalawa nitong nitong paa paa o kinaya sao sa posisyong posisyong ito ito ay ay kinaya may may alak-lakan. alak-lakan. momo angang pasyente, pasyente, maari maari ka ng ka ng tumayo tumayo at pumunta at pumunta sa istasyon sa istasyon o ambulansya. o ambulansya. 11.11. (ang (ang hakbang hakbang na na ito ito ay ay ginagawa ginagawa ng ng mabilis mabilis hindi hindi nangangahulugan nangangahuluganna na magtatagal magtatagal ka ka sa sa “power “power squat squat posisyon”) posisyon”)

UNIT NIT 11 DAY AY 66

FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE FOUNDATION

FOUNDATION FOUNDATION OF OF EMT EMT PRACTICE PRACTICE FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE 6

LOVER’SCARRY CARRY LOVER’S

LOVER’S CARRY

ddle le o o syon, on, soat at eha-hay ayay may ang bilang wak hawak era. urera. gat angat gsan san e nteo1o NIT T 1 may kamay

8. 8. Humanda Humanda sasa pagtayo, pagtayo, pasyente pasyenteat atmasupormasuporilapiit ilapiitang angkatawan katawanngng tahan momo angang kanyang tahan kanyang pasyente pasyentesasaiyong iyongkatakatabigat. Siguraduhin dindin na na bigat. Siguraduhin wan wanupang upangmas masmadali madali angang iyong likod ay nakadiiyong likod ay nakadiitong itong buhatin, buhatin, 9.retcho. 9. retcho. Bigyan Bigyanngngdireksyon direksyonang ang 5. 5.habang nakaluhod kunin habang nakaluhod pasyente pasyente nanaikaw ikaw aykunin ayta-taangang kamay ng pasyente attatlo kamay ng pasyente at tayo tayo sasa bilang bilang ngngtatlo ipatong sa iyong balikat atngat ipatong saay iyong balikat kaya kaya sya sya aykumapit kumapit ng angang isang kamay nito ay isang kamay nito ay mabuti. mabuti. UNIT UNIT 1 ipahawak mabuti sa sa kamabuti ka10. 10.ipahawak Marahang Marahang iangat iangat ang ang DAY DAY 6 maymay na nasa balikat mo. na nasa balikat mo. pasyente pasyente sa sa “power “power squat squat 6. 6.AngAng kamay na na nakasukamay nakasuPosition” Position” bago bago tumayo. tumayo. ItoIto ayay magbibigay sayo ngng porta samagbibigay baywang aysayo ilipat porta sa baywang ay ilipat ideya ideya kung kung kakayanin kakayaninmo mo sa balikat ng pasyente. sa balikat ng pasyente. baba ang ang iyon iyon gpasyenteng gpasyenteng 7. 7.AngAng isang kamay naman isang kamay naman buhatin buhatin osaohindi. hindi. Kung Kung sa ay ay ilagay ilalim ngsa ilagay sa ilalim ng posisyong posisyong itoito aypaa ayokinaya kinaya dalawa nitong paa sa dalawa nitong o sa mo moang angpasyente, pasyente,maari maari alak-lakan. maymay alak-lakan. kaka ngng tumayo tumayo at at pumunta pumunta sasa istasyon istasyon o ambulansya. o ambulansya. 11.11.(ang (anghakbang hakbangnanaitoitoayay ginagawa ginagawa ngng mabilis mabilis hindi hindi nangangahulugan nangangahulugan nana magtatagal magtatagalkakasasa“power “power squat squat posisyon”) posisyon”)

FOUNDATION FOUNDATION OFOF EMT EMT PRACTICE PRACTICE FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE

AY Y 66

tenana ang abang hita g hita

igusigunasa nasa ang upang ayo, o, ang s ng ang ng porsuporaataang nyang ali dali dinnana adiakading ang a-taunin kunin lo atlo NIT 11 UNIT e at at nte ng ng at at at AY 66 kat DAY o ayay ito ng ang kaa kaquat at o. mo. to . Ito asuakasung ng ipat y mo ilipat mo ng eng e. man g sa sa aman naya yangng m oari sa aari o sa unta ta a.ya. ayay di indi nana er wer

² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE

² Limmer²(Brady) Limmer (Brady) ³ Pollack,³(AAOS) Pollack, (AAOS) ⁴ NHTSA⁴ NHTSA

MGA HAKBANG:

² Limmer ² Limmer (Brady)(Brady) ³ Pollack, ³ Pollack, (AAOS)(AAOS) ⁴ NHTSA ⁴ NHTSA

1. Mula sa Tripod/Straddle o nakatayong posisyon, hawakan ang braso at kamay ng pasyente habang ang isang kamay ay nakaalalay sa kabilang bahagi habang hawak ang baywang o sinturera. 2. Dahan-dahang iangat hanggang sa kung saan lang kaya ng pasyente o lebel ng kanyang kamay ang kanyang braso. 3. Ipaalam sa pasyente na ikaw ay luluhod habang siya ay uupo sa iyong hita sa bilang na tatlo. 4. Sa iyong pagluhod, siguraduhin na ito ay nasa 90 º na angulo upang makaupo nang maayos ang pasyente at masuportahan mo ang kanyang bigat. Siguraduhin din na ang iyong likod ay nakadiretso. 5. Habang nakaluhod, kunin ang kamay ng pasyente at ipatong sa iyong balikat at ang isang kamay nito ay ipahawak mabuti sa kamay na nasa balikat mo. 6. Ang kamay na nakasuporta sa baywang ay ilipat sa balikat ng pasyente. 7. Ang isang kamay naman ay ilagay sa ilalim ng dalawa nitong paa o sa may alak-alakan. 8. Humanda sa pagtayo, ilapit ang katawan ng pasyente sa iyong katawan upang mas madali itong buhatin, 9. Bigyan ng direksyon ang pasyente na ikaw ay tatayo sa bilang ng tatlo kaya siya ay kumapit nang mabuti. 10. Marahang iangat ang pasyente sa “power squat position” bago tumayo. Ito ay magbibigay sa iyo ng ideya kung kakayanin mo ba ang iyong pasyenteng buhatin o hindi. Kung sa posisyong ito ay kinaya mo ang pasyente, maari ka nang tumayo at pumunta sa istasyon o ambulansya. 11. Ang hakbang na ito ay ginagawa nang mabilis at hindi nangangahulugan na magtatagal ka sa power squat position. ² Limmer ² Limmer (Brady) (Brady)

² Limmer (Brady) ³ Pollack, (AAOS) ² Limmer (Brady) ⁴ NHTSA ³ Pollack, (AAOS) ⁴ NHTSA

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

² Limmer² (Brady) Limmer (Brady) ³ Pollack,³ (AAOS) Pollack, (AAOS) ⁴ NHTSA⁴ NHTSA

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

LIFELINE ² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

PREHOSPITAL EMERGENCY CARE

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kaya kaya nito nito habang habang ang ang isangisang paa paa ay naihakbang ay naihakbang bahagya bahagya sa bandang sa bandang una- unahan han 2. Dahan-dahang 2. Dahan-dahang lumusot lumusot sa sa ilalimilalim ng braso ng braso nito nito ha- habangbang patuloy patuloy na nakasuna nakasuportaporta sa ang sa ang kabilang kabilang kamay kamay sa katawan sa katawan nito. nito. 3. Ang 3. Ang kamay kamay na nakahana nakahawak wak sa kamay sa kamay ng pasyenng pasyentengteng nasanasa balikat balikat mo ay mo ay kukunin kukunin ang ang kamay kamay ng ng pasyente pasyente sa kabilang sa kabilang ba- bahagi.hagi. 4. Sa 4. isang Sa isang mabilis mabilis na pagkina pagkiMGA MGA HAKBANG: HAKBANG: los, bitawan los, bitawan ang baywang ang baywang 1. 1.ng Mula Mula sa Tripos/ Tripos/ Straddle Straddle o pasyente, ngsapasyente, padaanin padaanin sa o sa nakatayon nakatayon gposisyon, gposisyon, pagitan pagitan ninyong ninyong dalwa dalwa iangat iangat ang kamay kamay at braso atatbraso ang kamay angang kamay na bumitaw na bumitaw at ngng pasyente pasyente sa lebel lebel na mabilis mabilis na hawakan na sa hawakan angnaang kaya kaya nito nito habang habang ang ang kamay kamay na na nasanasa iyongiyong isang isang paapaa ay ay naihakbang naihakbang balikat. balikat. bahagya bahagya sa bandang bandang unauna5. Nakaekis 5. Nakaekis na sa ang na ang iyong iyong han han kamay kamay pag pag nagawa nagawa mo mo 2. 2.ito. Dahan-dahang Dahan-dahang lumusot lumusot sa sa Ihakbang ito. Ihakbang ang ang pangpang nasa nasa bandang bandang likod likod ilalim ilalim ng ng braso braso nito nito hahapatungo patungo sa harapan sanaharapan ng ng bang bang patuloy patuloy na nakasunakasupasyente pasyente upan habang habang porta porta sa upan saang ang kabilang kabilang isinasabay isinasabay ang pageekis pageekis kamay kamay sa katawan saang katawan nito. nito. naman ngkamay kamay ng na kamay nito. nito. 3. 3.naman Ang Ang kamay nanakahanakaha6. Ikaw 6. Ikaw dapat dapat ay nasa ay nasa haraharawak wak sa sa kamay kamay ngng pasyenpasyenpan pan nanasa ng na balikat pasyente ngbalikat pasyente teng teng nasa mona mo ay na ay ang ang iyongiyong posisyon posisyon ayngng ay MGA HAKBANG: kukunin kukunin ang angkamay kamay MGA HAKBANG: maayos maayos at “stable”, at “stable”, ilipat ilipat pasyente pasyente sa sa kabilang kabilang Mula sa Tripos/ Straddle o 1. 1.Mula sa Tripos/ Straddle oba-baang ang pagkakapit pagkakapit sa kamay sa kamay hagi. hagi. nakatayon gposisyon, nakatayon braso at braso ng gposisyon, pasyente ng pasyente sa sa 4. iangat 4.at Sa Sa isang isang mabilis mabilis nabraso na pagkipagkiiangat ang kamay at braso ang kamay at bandang bandang ibabaw ibabaw lamang lamang los, los, bitawan bitawan ang ang baywang baywang ng pasyente sa lebel ng sa siko. lebel na na ngpasyente kanyang ng kanyang siko. ngng pasyente, pasyente, padaanin padaanin sa sa nito habang nito habang ang 7. kaya Dahandahang 7.kaya Dahandahang iangat iangat angang ang pagitan pagitan ninyong ninyong dalwa dalwa isang ay isang paapaa ay naihakbang pasyente pasyente at humanda at naihakbang humanda sa sa ang ang kamay kamay na na bumitaw bumitaw at bahagya sa bandang unapaglakad. paglakad. bahagya sa bandang una- at mabilis mabilis na na hawakan hawakan ang ang han han kamay kamayna nalumusot nasa nasa iyong Dahan-dahang lumusot sa 2. 2.Dahan-dahang saiyong balikat. balikat. ilalim braso ilalim ng ng braso nitonito ha- ha5. bang 5.Nakaekis Nakaekis na na ang ang iyong iyong bang patuloy nakasupatuloy na na nakasukamay kamay pag nagawa nagawa momo porta sa ang kabilang porta sa pag ang kabilang ito. ito.Ihakbang ang ang pang pang kamay sa katawan nito. kamay sa Ihakbang katawan nito. nasa nasa bandang bandang likod likod kamay nakaha3. 3.AngAng kamay na na nakahapatungo patungo sa saharapan harapan ngng sa kamay pasyenwakwak sa kamay ng ng pasyenpasyente pasyente upan upanhabang habang teng nasa balikat teng nasa balikat mo mo ay ay isinasabay isinasabayang angpageekis pageekis kukunin kamay kukunin angang kamay ng ng naman naman ngng kamay kamay nito. nito. pasyente sa kabilang pasyente sa kabilang ba- ba6. 6.Ikaw Ikaw dapat dapat ay ay nasa nasa haraharahagi. hagi. pan pan na na ngng pasyente pasyente na na 4. 4.Sa isang mabilis na pagkiSa isang mabilis na pagkiang angiyong iyongposisyon posisyonay ay los,los, bitawan angang baywang bitawan baywang maayos maayos at at “stable”, “stable”, ilipat ilipat ng ng pasyente, padaanin sa sa pasyente, padaanin ang ang pagkakapit pagkakapit sa sa kamay kamay pagitan ninyong dalwa ninyong dalwa atpagitan at braso braso ng ng pasyente pasyente sa sa ang kamay na bumitaw at at ang kamay na bumitaw bandang bandang ibabaw ibabaw lamang lamang mabilis na hawakan ang mabilis na hawakan ang ngng kanyang kanyang siko. siko. na nanasa iyong kamay nasa iyong 7. kamay 7.Dahandahang Dahandahang iangat iangat ang ang balikat. balikat. pasyente pasyente at at humanda humanda sa sa 5. 5.Nakaekis na ang iyong Nakaekis paglakad. paglakad.na ang iyong

UNIT UNIT 11

PACKSTRAP STRAPCARRY CARRY PACK PACK STRAP CARRY

/raddle Straddle o o osisyon, gposisyon, may at braso at braso lebel a lebel na na ng bangangang naihakbang hakbang ang ndang unauna-

musot lumusot sa sa nito o nito ha-hana nakasunakasugkabilang kabilang wan nito. nito. na nakahanakahang pasyenpasyentkat momo ay ay may kamay ng ng abilang ang ba-ba-

FIREFIGHTER’S CARRY WITH ASSISTANCE

UNIT UNIT 1 1 FOUNDATION EMT PRACTICE FOUNDATION OFOF EMT PRACTICE DAY 6 DAY 6PRACTICE FOUNDATION FOUNDATION OFOF EMT EMT PRACTICE

UNIT T1 1 YDAY 6 6

na s na pagkipagkibaywang g baywang aanin adaanin oddle osa sa ong dalwa dalwa ,syon, bumitaw omitaw brasoat at wakan kan angang bel a na aasaiyong iyong

g ang ggkbang angiyong iyong awa agawa momo g - una-

gang pang pang

at ang ang nda sa sa

FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE

LIFTING AND CARRYING PATIENTS FOUNDATION OF OFEMT EMTPRACTICE PRACTICE FOUNDATION FOUNDATIONOF OFEMT EMT PRACTICE PRACTICE DAY DAY 6 6 Day 6FOUNDATION

UNIT UNIT 11 DAY DAY 66

usot ang likod salikod arapan pan ng ng -o hanhabang habang NIT 1 UNIT 1 akasu- pageekis g pageekis AY 66 gDAY bilang nito. ay nito. ito. sa nasa haraharaasyente ente na na akahasyon osisyon ay ay asyene”, ilipat mo yable”, ayilipat at sa kamay kamay g ay pasyente yentengsa sa ng - lamang baaw lamang eddle o o o. isyon, on, ngat iangat angang -pagkitumanda braso aso ywang ganda sa sa bel na na anin sa g angang adalwa kbang ang taw tg at unanagn ang gusot iyong t sa sa to ha- hagakasuiyong asuoabilang mo ang gito. pang dakahalikod hag an ng asyenengmo abang ay ay sgeekis ay ng ng o. bang ba- harapagkiagkite na ang on yywang ay sa sa tnin ilipat dalwa wa ykamay taw at w at a nte sa n ang ang amang g iyong ong g at ang ong nda a iyong sa wa momo pang ang likod od an ng ng abang ang geekis ekis to. aaraharante na na on ay ay ,pat ilipat kamay may nte sa sa amang ang

isang isang paa ay naihakbang ay naihakbang mabilis mabilis napaa na hawakan hawakan angang bahagya bahagya sa na bandang sa bandang unaunakamay kamay na nasa nasaiyong iyong hanbalikat. han balikat. 2. 2. Dahan-dahang Dahan-dahang lumusot lumusot sa 5. 5.Nakaekis Nakaekis na na angang iyong iyongsa ilalim ilalim ng braso braso nitonito ha-mo hakamay kamay pagng pag nagawa nagawa mo UNIT UNIT 11 bang bang patuloy patuloy na nakasunapang nakasuito. ito. Ihakbang Ihakbang angang pang porta porta sa sa angang kabilang kabilang nasa nasa bandang bandang likod likod DAY DAY 66 kamay kamay sa katawan katawan nito.nito. patungo patungo sasa sa harapan harapan ng ng 3. 3. Ang Ang kamay kamay na na nakahanakahapasyente pasyente upan upan habang habang wakisinasabay wak sa kamay sa ang kamay ngpageekis pasyenng pasyenisinasabay ang pageekis teng teng nasa balikat balikat mo mo ay ay naman naman ngnasa kamay ng kamay nito. nito. kukunin kukunin ang ang kamay kamay ng ng 6. 6.Ikaw Ikaw dapat dapat ay nasa ay nasa haraharapasyente pasyente sang kabilang sa pasyente kabilang babapan pan na na ng pasyente na na MGA MGA HAKBANG: HAKBANG: hagi. hagi. ang ang iyong posisyon posisyon ay 1. 1.Mula Mula sa Tripos/ saiyong Tripos/ Straddle Straddle o ay o 4. nakatayon 4. Sanakatayon isang Sa isang mabilis na pagkina pagkimaayos maayos at “stable”, atmabilis “stable”, ilipat ilipat gposisyon, gposisyon, los, bitawan los, bitawan ang ang baywang baywang ang ang pagkakapit pagkakapit saatkamay sa iangat iangat ang ang kamay kamay braso at kamay braso ngng pasyente, ngpasyente pasyente, padaanin padaanin sana sa at braso at braso ng ng pasyente pasyente sa sa ng pasyente sa sa lebel lebel na pagitan pagitan ninyong ninyong dalwa dalwa bandang bandang ibabaw ibabaw lamang lamang kaya kaya nitonito habang habang ang ang ang ang kamay kamay na bumitaw na bumitaw at ngisang kanyang ngpaa kanyang siko. isang paa aysiko. ay naihakbang naihakbangat mabilis mabilis na hawakan nabandang hawakan ang ang 7. 7. Dahandahang Dahandahang iangat iangat ang ang bahagya bahagya sa bandang sa unaunakamay kamay na nasa nasa iyong iyong pasyente pasyente at na humanda at humanda sa sa han han balikat. balikat. paglakad. paglakad. 2. 2.Dahan-dahang Dahan-dahang lumusot lumusot sa sa 5. ilalim 5. Nakaekis Nakaekis na na ang ang iyong iyong ilalim ng ng braso braso nitonito ha-hakamay kamay pag pag nagawa mo mo bang bang patuloy patuloy na nagawa na nakasunakasuito.porta ito. Ihakbang ang ang pang pang porta saIhakbang saangang kabilang kabilang nasa nasa bandang bandang likod kamay kamay sa katawan sa katawan nito. nito.likod patungo patungo sa harapan sa harapan ng ng 3. 3.Ang Ang kamay kamay na na nakahanakahapasyente pasyente upan upan habang habang wak wak sa kamay sa kamay ng ng pasyenpasyenisinasabay isinasabay ang ang pageekis teng teng nasa nasa balikat balikat mopageekis mo ay ay naman naman ng kamay ng kamay nito.nito. kukunin kukunin ang ang kamay kamay ng ng 6. 6. IkawIkaw dapat dapat ay nasa ay nasa haraharapasyente pasyente sa sa kabilang kabilang ba-bapanpan na na ng ng pasyente pasyente na na hagi. hagi. angang iyong iyong posisyon posisyon ay ay 4. 4.Sa Sa isang isang mabilis mabilis na na pagkipagkimaayos maayos at “stable”, at “stable”, ilipatilipat los,los, bitawan bitawan angang baywang baywang angang pagkakapit pagkakapit sa kamay sa kamay ng ng pasyente, pasyente, padaanin padaanin sa sa at braso at braso ng ng pasyente pasyente sa sa pagitan pagitanninyong ninyongdalwa dalwa bandang bandang ibabaw ibabaw lamang lamang angang kamay kamay na na bumitaw bumitaw at at ng kanyang ng kanyang siko.siko. mabilis mabilis na na hawakan hawakan angang 7. 7. Dahandahang Dahandahang iangat iangat angang kamay kamayna nanasa nasaiyong iyong pasyente pasyente at humanda at humanda sa sa balikat. balikat. paglakad. paglakad. 5. 5.Nakaekis Nakaekisna naangangiyong iyong kamay kamay pagpag nagawa nagawa momo ito.ito. Ihakbang Ihakbang angang pang pang nasa nasa bandang bandang likod likod patungo patungo sa sa harapan harapan ng ng pasyente pasyenteupan upanhabang habang isinasabay isinasabay angang pageekis pageekis naman naman ng ng kamay kamay nito. nito. 6. 6.Ikaw Ikaw dapat dapat ay ay nasa nasa haraharapanpan na na ng ng pasyente pasyente na na angangiyong iyongposisyon posisyonay ay maayos maayos at at “stable”, “stable”, ilipat ilipat angang pagkakapit pagkakapit sa sa kamay kamay at at braso braso ng ng pasyente pasyente sa sa bandang bandang ibabaw ibabaw lamang lamang ng ng kanyang kanyang siko. siko. 7. 7.Dahandahang Dahandahang iangat iangat angang pasyente pasyente at at humanda humanda sa sa paglakad. paglakad.

FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

kamay pagpag nagawa mo mo kamay nagawa ito. ito. Ihakbang angang pang Ihakbang pang nasa nasabandang bandanglikod likod patungo sa harapan ng patungo sa harapan ng pasyente upan habang pasyente upan habang isinasabay angang pageekis isinasabay pageekis naman ng kamay nito.nito. naman ng kamay 6. 6.Ikaw dapat ay nasa haraIkaw dapat ay nasa harapanpan na na ng ng pasyente na na pasyente angang iyong posisyon ay ay iyong posisyon maayos at “stable”, ilipat maayos at “stable”, ilipat angang pagkakapit sa kamay pagkakapit sa kamay at braso ng pasyente sa at braso ng pasyente sa bandang ibabaw lamang bandang ibabaw lamang ng ng kanyang siko.siko. kanyang 7. 7.Dahandahang iangat angang Dahandahang iangat pasyente at humanda sa sa pasyente at humanda paglakad. paglakad.

² Limmer² (Brady) Limmer (Brady) ³ Pollack,³ (AAOS) Pollack, (AAOS) ⁴ NHTSA⁴ NHTSA

MGA HAKBANG:

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

² Limmer ² Limmer (Brady)(Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

² Limmer ² Limmer (Brady)(Brady) ³ Pollack, ³ Pollack, (AAOS)(AAOS) ⁴ NHTSA ⁴ NHTSA

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

1. Mula sa Tripod/Straddle o nakatayong posisyon, iangat ang kamay at braso ng pasyente sa lebel na kaya nito habang ang isang paa ay naihakbang bahagya sa bandang unahan. 2. Dahan-dahang lumusot sa ilalim ng braso nito habang patuloy na nakasuporta ang kabilang kamay sa katawan nito. 3. Ang kamay na nakahawak sa kamay ng pasyenteng nasa balikat mo ay kukunin ang kamay ng pasyente sa kabilang bahagi. 4. Sa isang mabilis na pagkilos, bitawan ang baywang ng pasyente, padaanin sa pagitan ninyong dalawa ang kamay na bumitaw at mabilis na hawakan ang kamay na nasa iyong balikat. 5. Nakaekis na ang iyong kamay pag nagawa mo ito. Ihakbang ang paang nasa bandang likod patungo sa harapan ng pasyente habang isinasabay ang pageekis naman ng kamay nito. 6. Ikaw dapat ay nasa harapan na ng pasyente na ang iyong posisyon ay maayos at matatag. Ilipat ang pagkakapit sa kamay at braso ng pasyente sa bandang ibabaw lamang ng kanyang siko. 7. Dahan-dahang iangat ang pasyente at humanda sa paglakad. ² Limmer (Brady) ³ Pollack, (AAOS)(Brady) ² Limmer ⁴ NHTSA ³ Pollack, (AAOS) ⁴ NHTSA

² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

158

LIFELINE

² Limmer (Brady) ² Limmer (Brady)

PREHOSPITAL EMERGENCY CARE

MGA MGA HAKBANG: HAKBANG: MGA MGA HAKBANG: HAKBANG: MGA MGA HAKBANG: HAKBANG:

1.1. 1. Gawin Gawin ang ang hakb hh 1. Gawin Gawin ang ang hakb MGA HAKBANG: MGA HAKBANG: PACKSTRAP PACKSTRAP TECH TT PACKSTRAP PACKSTRAP TEC 1. 1. Gawin Gawin angang hakb h hanggang hanggang sasapage sa p hanggang hanggang sa pag PACKSTRAP PACKSTRAP TEC Tp 1.1. Gawin ang ha Gawin h kamay kamay ng ng pasye pp kamay kamay ngang ng pasy hanggang hanggang sa pag saTE p PACKSTRAP PACKSTRAP pagpunta pagpunta mo mo sasapTh pagpunta pagpunta mo mo kamay kamay ng ng pasy hanggang hanggangsasapap nito. nito. nito. nito. pagpunta pagpunta mo mo sa kamay ng pap kamayang ng 2.2. 2. Hawakan Hawakan ang alak 2. Hawakan Hawakan ang ala nito. nito. ang pagpunta mo s pagpunta mosa ng paa ng paa kung kung san n ngnito. ng paa paa kung kung san sa 2. 2. Hawakan Hawakan ang ang ala nito. ang ang kamay kamay na na ang ang kamay kamay na n n ng paa ng paa kung kung san s 2.2. Hawakan ang Hawakan anga baw baw ng ng pagka baw baw ngpagkakae ng pagkaka pagka ang ang kamay kamay nasan nn ng paa kung ng paa kung sa padaanin padaanin sa ilalim sa il padaanin padaanin sapagka sa ilalim baw baw ngkamay ng pagkakae ang nanil ang kamay gat gat bahagya bahagya gat gat bahagya bahagya ang akil padaanin padaanin saang ilalim sa an baw ng baw ngpagkak pagka paa paa at hawakan at hawak paa paa at at hawakan hawak gat gat bahagya bahagya ang padaanin sa ilaail padaanin sa may may na na nakaturo naka may may nahawakan na nakatu naka paa paa at at hawak gat ana gatbahagya bahagya gawin gawin ang ang pareho par gawin gawin ang ang pareh par may may na na nakatur naka paa at hawaka paa at hawak bang bang sasa kabilang sa kabilan p bang bang kabilang saang kabilan gawin gawin ang pareho par may na nakat may na naka 3.3. 3. Dahand-dahang Dahand-dahan 3. Dahand-dahang Dahand-dahan bang bang sa kabilang sa kabila p gawin ang pare gawin ang par kapag kapag parehong pareho kapag kapag parehong pareho 3. 3. Dahand-dahang Dahand-dahan bang sa kabilang bang sa kabilan naiangat naiangat na haban na ha naiangat naiangat na na haba h kapag parehong pareho 3. kapag Dahand-dahang 3. Dahand-dahan ekis ekis ang ang kamay kam ekis ekis ang ang kamay kam naiangat naiangat na haba na h kapag parehon kapag pareho iyong iyong hawak. hawak. iyong iyong hawak. hawak. ekis ekis angang kamay naiangat nakam hab naiangat na h iyong iyong hawak. hawak. ekis ang kama ekis ang kam iyong hawak. iyong hawak.

UNIT UNIT 11 1 UNIT UNIT 1 DAY DAY 616 6 UNIT UNIT 1 DAY DAY 6 UNIT UNIT DAY DAY 611 6 DAY66 DAY

FOUNDATION FOUNDATION OF OF EMT EMT PRACTICE PRACTICE FOUNDATION FOUNDATION OF OF EMT EMT PRACTICE PRACTICE FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE FOUNDATION OF EMTPRACTICE PRACTICE FOUNDATION OF EMT PIGGY BACK CARRY CARRY PIGGY PIGGY BACK BACK CARRY CARRY PIGGY PIGGYBACK BACKCARRY CARRY PIGGY BACKCARRY CARRY PIGGY BACK CARRY BACK PIGGY

bang hakbang hakbang bang ng ngng ng TECHNIQUE HNIQUE CHNIQUE TECHNIQUE hakbang bang ng ng pageekis eekis ng ng geekis pageekis ng ng CHNIQUE TECHNIQUE akbang ngng hakbang pasyente ente atat at pasyente yente at geekis pageekis ng ng ECHNIQUE TECHNIQUE harapan sa harapan sa harapan harapan pasyente yente at at ageekis pageekisngng harapan sa harapan asyente atat k-alakan alak-alakan gpasyente ak-alakan alak-alakan sa harapan sa harapan an nakaturo an nakaturo nakaturo gnakaturo ak-alakan alak-alakan anakaturo asanasa ibana nasa nasa iba-ibaibasan nakaturo alak-alakan gaekis alak-alakan ekis akaekis nito, nito, akaekis nito, nito, na nasa nasa ibaibanannakaturo nakaturo mlalim at ianat ianm lalim atnito, ianakaekis ekis nito, nasa ibana nasa ibakanyang ng kanyang ang kanyang kanyang m lalim at ianat iankaekis nito, akaekis nito, kan ang ang kakan kan ang ang kaang kanyang kanyang alim at ianlalim atditto, ianaturo o ditto, uro aturo ditto, kan ang ang kakang kanyang ang kanyang ong rehong hakhakhong rehong hakro aturo ditto, ditto, an ang kakan ang kapaa. ng paa. ng paa. paa. ong rehong hakhakturo ditto, aturo ditto, ng tumayo tumayo ng tumayo tumayo ang paa. paa. ehong hakrehong hakong ay g ong paapaa ay ay ng tumayo tumayo gpaa paa. ng paa. abang ng naka naka habang naka ong paa paa ay ay gang tumayo ng tumayo may nito nito na may nito nito na habang angpaa naka naka ng ayna ong paa ay may nitonito na na bang naka habang naka ay nito na may nito na

UNIT UNIT11 DAY DAY66

Patient Positioning Positioning the patient during transfer to the ambulance and during transportation is a very important part of your care. Lifting, moving, and transport must be performed as an integral part of your total patient-care plan. The position in which the patient is transported depends on his medical condition and the device best designed to help this condition.

FOUNDATION FOUNDATIONOF OFEMT EMTPRACTICE PRACTICE

Patient PatientPositioning Positioning

Unresponsive patients with no suspected spine injury should be placed induring the recovery position. The patient should Positioning Positioning the the patient patient during transfer transfer toto the the ambulance ambulance and and during during transportatransportabe side to aidpart drainage from his mouth and, ifand he tion tion is on is a very ahis very important important part ofof your your care. care. Lifting, Lifting, moving, moving, and transport transport must must bebe vomits, as toashelp prevent his breathing thepatient-care vomitus into his The performed performed ananintegral integralpart partof ofyour yourtotal total patient-care plan. plan. Theposition positionin in which which the the patient patient is transported transported depends depends on hishis medical medical condition condition and and the the de-delungs. This canisbe accomplished on aon wheeled stretcher. vice vice best best designed designed toto help help this this condition. condition. You should avoid transporting the unresponsive patient in a chair-type device since the airway cannot be properly Unresponsive Unresponsive patients patients with with nonosuspected suspectedspine spineinjury injuryshould shouldbebe beplaced placedin inthe the maintained. A patient with suspected spine injury should recovery recoveryposition. position.The Thepatient patientshould shouldbebeononhishisside sidetotoaidaiddrainage drainagefrom fromhishis immobilized on a long backboard. mouth mouth and, and, if he if he vomits, vomits, toto help help prevent prevent hishis breathing breathing the the vomitus vomitus into into hishis lungs. lungs. This This can can bebe accomplished accomplished onon a wheeled a wheeled stretcher. stretcher. You You should should avoid avoid transporting transporting Many patients who no suspected spine injuries the the unresponsive unresponsive patient patient in in ahave chair-type a chair-type device device since since the the airway airway cannot cannot bebe proppropmay be transported inwith awith position of comfort. .This includes erly erly maintained. maintained. AA patient patient suspected suspected spine spine injury injury should should bebe immobilized immobilized onon a long a many long backboard. backboard. patients with medical complaints such as chest pain,

nausea, or difficulty of breathing. In this situation, allow

Many Many patientswho have have nosuspected suspected spine spine injuries injuriesmay may bebetransported transportedin ina a thepatients patient towho choose ano position he feels comfortable in. position position ofof comfort. comfort. .This .This includes includes many many patients patients with with medical medical complaints such Breathing is often aided by raising the back of the stretchercomplaintssuch asas chest chest pain, pain, nausea, nausea, oror difficulty difficulty ofof breathing. breathing. InIn this this situation, situation, allow allow the the patient patient sochoose thatathe patientheis infeels a comfortable semi-sitting position, also the toto choose position a position he feels comfortable in. in. Breathing Breathing is called is often often aided aided byby raising raising Fowler or semi-Fowler position. The position must be safe the theback backofofthe thestretcher stretchersosothat thatthe thepatient patientis isin ina asemi-sitting semi-sittingposition, position,also also andthe not prohibit the proper use of any The transportation device. called called theFowler Fowleroror semi-Fowler semi-Fowler position. position. Theposition positionmust must bebesafe safeand andnot not The position of comfort must be used cautiously in case the ofofcomfort prohibit prohibit the theproper proper use useofofany anytransportation transportation device. device. The The position position comfort must must bebe used used cautiously cautiously in in case case the the patient patient vomits. vomits. Always Always monitor monitor patients patient vomits. Always monitor the patients airway and level thethepatients airway airway and and level level ofof responsiveness. responsiveness. Place Place the the patient patient in in the the recovery recovery position position atat of responsiveness. Place the patient in the recovery position the the firstsign signofsign ofa adecreased level levellevel ofofresponsiveness. responsiveness. For Forthe thepregnant pregnantpatient patient atfirst the first ofdecreased a decreased of responsiveness. For with with hypotension, hypotension, anan early early intervention intervention is is toto position position the patient patient onon her her leftleft side. side. the pregnant patient with hypotension, an earlythe intervention AA patient patient who who is is nauseated nauseated oror vomiting vomiting should should bebe transported transported in in aa position position ofof is to position the patient on her left be side. A patientappropriately who is comfort; comfort; however, however, the the EMT-Basic EMT-Basic should should be positioned positioned appropriately toto manage manage nauseated the the airway. airway. or vomiting should be transported in a position

of comfort; however, the EMT should be positioned appropriately to manage the airway.

COMFORTABLE COMFORTABLEPOSITION POSITION MGA HAKBANG:

² Limmer ² Limmer (Brady) (Brady) ² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ³ ²Pollack, ³⁴² Pollack, (AAOS) (AAOS) Limmer (Brady) (Brady) ⁴Limmer NHTSA ²NHTSA Limmer (Brady) ⁴³ NHTSA ⁴ NHTSA Pollack, ³ Pollack, (AAOS) (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA ⁴ NHTSA ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

COMFORTABLE POSITION

“ “

1. Gawin ang hakbang ng PACKSTRAP TECHNIQUE hanggang sa pag-eekis ng kamay ng pasyente at pagpunta mo sa harapan nito. 2. Hawakan ang alak-alakan ng paa kung saan nakaturo ang kamay na nasa ibabaw ng pagkakaekis nito. Padaanin sa ilalim at iangat bahagya ang kanyang paa at hawakan ang kamay na nakaturo dito. Gawin ang parehong hakbang sa kabilang paa. 3. Dahan-dahang tumayo kapag parehong paa ay naiangat na habang naka-ekis ang kamay nito na iyong hawak.

FOWLER’S

SEMI-FOWLER’S

FOWLER’S FOWLER’S

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MGA MGA HAKBANG HAKBANG : :

MGA HAKBANG : LIFTING AND CARRYING PATIENTS Day 6 1. 1. Mula Mulasa sapagkakahigang pagkakahigang MGA HAKBANG : 1. Mula sa pagkakahigang posisyon posisyon ngng pasyente, pasyente, posisyon ng pasyente, pumwesto pumwestosa sagilid gilidnito. nito. 1.RECOVERY Mula sa pagkakahigang POSITION MGAangHAKBANG pumwesto sa gilid nito. Iangat Iangatang kamay kamay:na na posisyon ng pasyente, Iangat angsa kamay na malapit malapit sayo. sayo. pumwesto gilid nito. 1. ang Mula sakamay pagkakahigang malapit 2. 2. Kunin Kunin ang kamay na na ma-maIangat sayo. ang kamay na posisyon ng pasyente, 2. Kunin kamay na mamalapitang sayo. layo layo sayo sayo at atipatong ipatongsa sa pumuwesto sa gilid nito. layo sayo at ipatong sa 2. Kunin ang kamay na madibdib dibdib ng ng pasyente. pasyente. Iangat ang kamay na dibdib ng pasyente. layo sayo at ipatong sa 3. 3. Kunin Kunin ang ang paa paa na na malayo malayo malapit sa iyo. 3. Kunin ang paa na malayo dibdib ng pasyente. sayo sayo at at ipatong ipatong sa sa kabikabi2. Kunin ang kamay na ipatong kabi3. sayo Kuninatang paa nasamalayo lang lang paa. paa. malayo sa: iyo at ipatong sa MGA HAKBANG lang paa. sayo at ipatong sa kabi4. 4. Hawakan Hawakan ang ang baywang baywang dibdib ng pasyente. 4. Hawakan ang baywang lang paa. 3. Kunin ang paa na malayo at ang balikat balikat nito nito 1.at ang Mula sa pagkakahigang sa iyo at ipatong sa kabilang 4. at Hawakan ang ang balikat nitobaywang 5. 5. Dahan-dahang Dahan-dahang itagilig posisyon ng itagilig pasyente, paa. at ang balikat nito itagilig 5. Dahan-dahang ang ang pasyente pasyente papunta papunta sa sa pumwesto saang gilid nito. 4. Hawakan baywang at 5. Dahan-dahang itagilig ang pasyente papunta sa iyong iyong direksyon. direksyon. Iangat ang nito kamay na ang balikat ang pasyente papunta sa iyong direksyon. 6. 6. Panatilihin Panatilihin ang angpasyente pasyente malapit sayo. 5. Dahan-dahang itagilig ang iyong direksyon. 6. Panatilihin ang pasyente ganitong ganitong posisyon sa 2.sa sa Kunin ang posisyon kamay na mapasyente papunta sasa iyong 6. sa Panatilihin pasyente ganitongang posisyon sa loob loob ngdireksyon. ng 5 minute 5 minute o hango hanglayo sayo at ipatong sa sa ganitong posisyon loob ng 5 minute o hanggatgat kinakailangan. dibdib ng pasyente. 6.kinakailangan. Panatilihin angare pasyente Patients who believed lobe in shock are placedsa in a supine position. This alloobkinakailangan. ng 5 minute o hanggat sa ang ganitong sa 3. Kunin paaposisyon na malayo lows maximum blood flow throughout the body with minimal resistance from gat kinakailangan. limang minuto o sayo loob at ng ipatong sa kabigravity. It is important that all parts of the body—especially vital organs such as lang hangga’t paa. kinakailangan the brain—remain perfused. 4. Hawakan ang baywang at ang balikat nito 5. Dahan-dahang itagilig Patients who have experienced trauma (injury) arc placed on a spine board and ang pasyente papunta sa immobilized to prevent further injury. These patients should remain in a supine iyong direksyon. and levelang position on the backboard. Do not lower the head (which may cause 6. Panatilihin pasyente difficulty breathing) sa ganitong posisyon saor raise the legs (which may aggravate injury and make loob ng 5 minute omore hang-difficult). In this case, the risks of raising the legs outweigh transportation gat kinakailangan. the benefits. Recent research has shown there is minimal or no benefit to elevat-

NIT 1 DAY 6

FOUNDATION OF EMT PRACTICE 3

Positioning for Shock

ing the legs.

Positioning for Shock

Patients who are believed to be in shock are placed in a supine position. This allows maximum blood flow throughout the body with minimal resistance from gravity. It is important that all ² Limmer ² Limmer (Brady) (Brady) parts of the body—especially vital³ Pollack, organs such ³ Pollack, (AAOS) (AAOS)as ⁴ NHTSA ⁴ NHTSA the brain—remain perfused.

Patients who have experienced trauma (injury) are placed on a spine board and immobilized to prevent further injury. These patients should remain in a supine and level position on the backboard. Do not lower the head (which may cause difficulty breathing) or raise the legs (which may aggravate injury and make ² Limmer (Brady) transportation more difficult). In this case, the risks of raising ³² Limmer Pollack, (Brady) (AAOS) ⁴³ Pollack, NHTSA(AAOS) the legs outweigh the benefits. Recent research has shown there is ⁴ NHTSA minimal or no benefit to elevating the legs.

SUPINE POSITION

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

PREHOSPITAL EMERGENCY CARE

TRENDELENBERG POSITION

Lifeline in Action

A POLITICIAN SUFFERS A HEART ATTACK

By PAUL VIOLETA, RN

A Lifeliner recalls his first day on the job It was my first day with Lifeline. My team leader was still orienting me to the various equipment and supplies inside the ambulance when a call came in for a patient suspected of a possible cardiac arrest. We hurriedly responded to the scene. On the way, we received another call from the Lifeline Red Room informing us that the patient was a politician. When we got into the patient’s house, everybody was in panic mode. The maid who found the patient was crying while the patient’s bodyguards were going up and down the stairs. The patient’s driver and cook, meanwhile, were shouting at each other. My team leader entered the room and found the patient lying inside the bathroom. I prepared the CPR equipment outside as my fellow EMT’s lifted the patient out of the bathroom. Poop was already present, which told us that the brain’s ability to control the bladder and bowel was already gone. CPR was done immediately. We tried to do a bag-valvemask ventilation and put an oropharyngeal airway but the jaw was already locked. I sensed that rigor mortis had already set in. I overheard the housemaid’s story that the patient got off from a long meeting in Malacañang Palace and went home to refresh himself before his next meeting. According to the main, the politician often went

inside the bathroom at around 9:00 am and would be out 30 minutes later. It was his daily routine. So it puzzled the maid when the politician did not come out after his regular schedule. The maid said she tried to check on him around 9:45 am but she could still hear the shower. The maid got suspicious when the politician did not respond to her loud knocking on the bathroom door. It was then that the politician’s bodyguards called Lifeline 16-911 for assistance. We managed to do our best to bring the patient to the nearest hospital. The hospital’s resuscitation team was already at the ER entrance waiting for us. A verbal endorsement was done while the ER team and ambulance team switched places. Despite our best efforts, however, the patient did not survive.

I PREPARED THE CPR EQUIPMENT OUTSIDE AS MY FELLOW EMT’S LIFTED THE PATIENT OUT OF THE BATHROOM. POOP WAS ALREADY PRESENT, WHICH TOLD US THAT THE BRAIN’S ABILITY TO CONTROL THE BLADDER AND BOWEL WAS ALREADY GONE. LIFELINE

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SO you want to be a lifesaver? Here’s a friendly advise: Save your own life first. We’re not kidding you. As a lifesaver, you will be exposed to a lot of dangerous situations. And to get out of these situations alive and unscathed, you need to be smart. Part of being smart is the ability to evaluate a scene for safety. This is what you will learn today when you study scene size-up. Scene size-up is a very important part of your future job as an EMT. Unfortunately, it doesn’t get the attention it deserves in the training of EMTs, much more in actual practice. In classroom simulations, many students just wave their simulated gloved hands and magnanimously

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proclaim, “Scene safe!” as if a magic wand could be waved over the scene to make it free of everything dangerous, from violence to microbes. If only this were possible, or if only scene size-up were that simple. But no, it’s not. Scene size-up is a complex process of evaluating the scene to determine if it’s safe enough for you to enter, establishing a danger zone, calling for backup if necessary, and so on and so forth. A failure in sizing up a scene correctly could mean not only the death of a patient, but also the injury or even death of an EMT. You don’t want that to happen to you or your team. So better take this chapter seriously.

DAY

The Scene Size-Up Elements of Scene Size-Up Nature of the Call Nature of Illness Crime Scenes

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Day 7

CRITICAL CONCEPTS Scene size-up is a continuous process. It prevents further danger and aids on how best to approach a scene.

FOUNDATION OF EMT PRACTICE

THE SCENE SIZE-UP LEARNING OBJECTIVES

Mahirap hulaan ang mga mangyayari sa panahon ng emergency. Kaya naman napakahalaga para sa isang EMT na maging laging handa sa anumang puwedeng mangyari upang hindi malagay sa peligro ang kanyang buhay at ang buhay ng kanyang pasyente. Sa chapter na ito ay pagaaralan natin ang Scene Size-up o ang paraan ng pagsuri sa lugar kung saan naroon ang pasyente. Ito ang unang bahagi ng pagsusuri sa sitwasyon. Nagsisimula ito mula sa dispatch o pag-alis ng EMT sa base, hanggang sa ganap na matulungan ang pasyente. Sinusuri ang lugar upang matiyak ang sitwasyon at para makatawag ng dagdag na tulong kung kinakailangan.

After reading this topic, you will be able to identify hazards at a scene and determine if a scene is safe to enter to provide needed care. Also, you will understand what is mechanism of injury and how it affects a patient’s condition.

INTRODUCTION As an EMT, you must approach every case using scene size-up. This begins with the dispatch and continues until the end of each call. You must check the scene to determine possible threats to your own safety, the safety of your crew. the patient, as well as bystanders. You also have to evaluate the scene to know the nature of the call and if additional help is required. However, scene size-up is not confined to the first part of the assessment process. These considerations should continue throughout the call since emergencies are dynamic and always changing. You may find that patients, family members, or bystanders who were not a problem initially become increasingly hostile later in the call or that vehicles or structures that seemed stable suddenly shift and pose a danger. You must carefully take note of the various findings of the scene, both for your own information and for other healthcare providers in the continuum of care. Your scene size-up will give you valuable insight as to the nature of the illness, mechanism of injury, and possible need for additional caution and resources. Only after your initial scene size-up will you become more directly involved in patient assessment and care. It is best to remember the key size-up elements throughout the call to prevent dangerous surprises later.

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You can obtain important information from just a brief survey of the scene. You might see a downed electrical wire at the scene of a vehicle collision, a potentially deadly situation for you as the EMT, your patient, and bystanders. Further observations of the scene are likely to reveal more important information about the mechanism of injury. Example: Damage to the steering wheel or windshield would be a strong indicator of potential chest, head, or neck injury caused by driver impact with those surfaces. A deployed airbag would cause you to assess for injuries airbags might cause, especially to an infant or child front-seat passenger. Just like your observations, the actions you take to obtain needed assistance and prevent further injury are equally important in your scene size-up. If there are two patients in a collision, you would request that a second ambulance be dispatched to the scene — more if you discovered that there were additional passengers. If there is a downed power line or electric post at the scene, which poses a danger of fire or electroqution, you would notify the Bureau of Fire Protection and the Manila Electric Company. You would also take steps to keep bystanders clear of traffic, the collision, and the patient/s.

Elements of Scene Size-Up As an EMT, you must bear in mind these elements the entire call duration. This will help you in preventing unexpected dangers that may arise in the situation since emergencies can change any moment. Do not assume that the scene is safe even if other rescue groups, the police, or firefighters have already arrived. Always perform your own scene size-up. These are the things you need to take note: 1. Check scene safety. 2. Observe standard precautions 3. Take note of the mechanism of injury or the nature of illness 4. Note the number of patients And 5. Get additional resources if necessary.

Before you arrive on-scene. the dispatcher may relay important information to you. A well-trained dispatcher uses a set of questions to determine information that may affect you directly. If the caller mentiones particular hazards, you could immediately call for additional specialized assistance. Often you will arrive at a scene where there are police, fire, and even other ambulances already present. In a situation like this, do not assume that the scene is safe or that others have taken care of any hazards. Always perform your own size-up no matter who arrives first. Scan for scene hazards, infection-control concerns, mechanisms of injury, and number of patients. The scene size-up begins even before the ambulance comes to a stop. Observe the scene while you approach and again before you exit the vehicle.

The following are Scene Safety Considerations (approaching a crash or hazardous material emergency): As you get near the collision scene: • Look and listen for other emergency service units approaching from side streets. • Look for signs of a collision-related power outage, such as darkened areas which suggest that wires are down at the collision scene. • Observe traffic flow. If there is no opposing traffic, suspect a blockade at the collision scene. • Look for smoke in the direction of the collision scene—a sign that fire has resulted from the collision.

When you are within sight of the scene: • Look for clues indicating escaped hazardous materials, such as a damaged truck, escaping liquids, fumes, or vapor clouds. If you see anything suspicious, stop the ambulance immediately and consult your hazardous material reference guide or hazardous-materials team, if one is available. • Look for collision victims on or near the road. A person may have been thrown from a vehicle as it careened out of control, or an injured person may have walked away from the wreckage and collapsed on or near the roadway. • Look for smoke not seen at a distance. • Look for broken utility poles and downed wires. At night, direct the beam of a spotlight or hand light on poles and wire spans as you approach the scene. Keep in mind that wires may be down several hundred feet from the crash vehicles.

• Be alert for persons walking along the side of the road toward the collision scene. Curious onlookers (excited children in particular) are often oblivious to vehicles approaching from behind. • Watch for the signals of police officers and other emergency service personnel. They may have information about hazards or the location of injured persons.

As you reach the scene: • If rescue and other emergency personnel are at the scene and are using the incident command/ management system, follow the instructions of the person in charge. This may involve the positioning of the ambulance, wearing protective equipment and apparel, determining where to find the patients, or being aware of specific hazards. The Incident Commander may he able to provide you with life-saving information regarding unstable conditions such as the stability of a building and the possibility of structural collapse. • Wear appropriate protective apparel, including head protection, jacket (or similar clothing that will protect you from sharp edges), and a reflective vest that goes over jacket. You should have extrication gloves easily available in a pocket. When temperature and weather are significant factors, be sure to protect yourself with clothing that will keep you dry. • Sniff for odors such as gasoline or any unusual odor that may signal a hazardous material release.

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THE SCENE SIZE-UP

Establishing the Danger Zone A danger zone is the area where special safety precautions must be taken. The size of the zone depends on the nature and severity of hazards. An ambulance should never be parked within the danger zone. Follow these guidelines in establishing the danger zone: • WHEN THERE ARE NO APPARENT HAZARDS. In this case, consider the danger zone to extend al least 50 feet in all directions from the wreckage. The ambulance will be away from broken glass and other debris, and it will not impede emergency service personnel who must work in or around the wreckage. • WHEN FUEL HAS BEAN SPILLED. In this case, consider the danger zone to extend a minimum of 100 feet in all directions from the wreckage and fuel. In addition to parking outside the danger zone, park upwind, if possible. Note the direction of the wind by observing the smoke. Make sure the ambulance is out of the path of dense smoke if the fuel ignites. If fuel is flowing away from the wreckage, park uphill as well as upwind. If parking uphill is not possible, position the ambulance as far from the flowing fuel as possible. Avoid gutters, ditches, and gullies that can carry fuel to the ambulance. • WHEN A VEHICLE IS ON FIRE. In this case, consider the danger zone to extend at least 100

Downed Lines In incidents involving downed electrical wires and damaged utility poles, the danger zone should extend beyond each intact pole for a full span and to the sides for the distance that the severed wires can reach. Slay out of the danger zone until the utility company has deactivated the wires, or until trained rescuers have moved and anchored them.

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feet in all directions even if the fire appears small and limited to the engine compartment. If fire reaches the vehicle’s fuel tank, an explosion could easily damage an ambulance parked closer than 100 feet. • WHEN WIRES ARE DOWN. In this case, consider the danger zone as the area in which people or vehicles might be in contact with live wires if the wires pivot around their points of attachment. Even though you may have to carry equipment and stretchers for a considerable distance, the ambulance should be parked at least one full span of wires away from the poles to which broken wires are attached. • WHEN A HAZARDOUS MATERIAL IS INVOLVED. You may be warned to park 200 feet or more from the wreckage, as when there is the possibility that certain high explosives may detonate. Park upwind. Park uphill if a liquid is flowing, but on the same level if there are gases or fumes which may rise. Park behind some artificial or natural barrier if possible.

Vehicle on Fire if no other hazards are involved, such as dangerous chemicals or explosives, the ambulance should park no closer than 100 feet (about 30 meters) from a burning vehicle. Park upwind,

Hazardous Material Threatened by Fire When hazardous materials are either involved in or threatened by fire. the sire of the danger zone is dictated by the native of the material. Use binoculars to read the placard on the truck and refer to the Emergency Response Guidebook for a safe distance lo establish your command post. Park upwind,

Spilled Fuel

Hazardous Materials

The ambulance should be parked upwind from flowing fuel. II this is not possible. The vehicle should be parked as far from the fuel. How as possible, avoiding gutters, ditches, and gullies that may carry the spill to the parking site. Remember, your ambulance’s catalytic convener is an ignition source over 1000 degrees Fahrenheit.

Leaking containers of dangerous chemicals may produce a health as well as a fire hazard. When chemicals have been spilled, whether fumes are evident or not. the ambulance Should be parked upwind, if the hazardous material is know, seek advice from experts through the Incident Commander.

UNIT 2 DAY 7

FUNDAMENTALS OF EM

STANDARD PRECAUTIONS

As you perform the scene, the points to con tant aspect o and one that y you have addr gers—is Stand called substanc

STANDARD PRECAUTIONS As you perform your initial size-up of the scene, there are many important points to consider. One very important aspect of personal protection— and one that you will need long after you have addressed any physical dangers— is Standard Precautions.

You learned a tions and per ment (PPE) in Being of the Simply put, these precautions and protective Body substanc equipment are meant to keep you safe. As you know by now, body fluids, including blood and saliva, and any other can carry viruses and bacteria. Your patient’s body Alt body subst fluids can enter your body through cuts or other and bacteria. Y openings in your skin. They can also easily enter stances can en another indication for protective eyewear your body through your eyes, nose, and mouth. You and Whenever a patient suspected cutsa mask, or other openings inisyour skin. They can also easily e are especially at risk of being infected by a patient’s of having tuberculosis or other diseasesYou that are especially at risk of your eyes, nose, and mouth. body fluids when the patient is bleeding, coughing, or spread through the air. wear a mask to filter out sneezing, or whenever you make direct contact with the tient's body substances when the patient is bleeding, co airborne particles the patient exhales. patient, as in mouth-to-mouth ventilation. whenever you make direct contact with the patient, as in Infection is a two-way street, of course. You can also lation. Infection is a two-way street, of course. You can als infect the patient. You studied Standard Precautions and personal protective equipment in when you were taught how to maintain your well-being as an EMT.

For example, at a vehicle collision that is likely to have caused severe injuries with bleeding, all personnel should wear protective gloves and eyewear. Since this potential hazard can be spotted before there is any contact with the patient, everyone should be wearing gloves before beginning patient care. If a patient requires suctioning or spits up blood, this would be

Isang mahalagang bahagi ng

ForStandard example, at a vehicle collision that is likely to have cau Precautions ang personal protective equipment. Siguraduhin na wear protective gloves a bleeding, all personnel should meron nito sa response kit mo. Laging potential hazard can be spotted before there is any co tandaan na ang Standard Precautions everyone should be wearing gloves before beginning p ay mag-iiwas sa iyo sa panganib. requires suctioning or spits up blood, this would be anoth tive eyewear and a mask, Whenever a patient is suspected or another disease spread through the air. wear an N-95 ticulate air (HEPA) respirator to filter out airborne particle expels. LIFELINE

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A key clement of Standard Precautions is always to ha equipment readily available, either on your person or as counter when opening a response kit. Remember that

NIT 2 DAY 7

FUNDAMENTALS OF EMT PRACTICE THE SCENE SIZE-UP

Day 7

NATURE OF THE CALL After you have ensured scene safety and taken the appropriate Standard Precautions, it is important to determine the nature of the call by identifying the mechanism of injury or the nature of the patient's illness. After you have ensured scene safety and taken the appropriate Standard Precautions, it is important to determine the nature of the call by identifying the mechanism of injury or the nature of the patient’s illness.

NATURE OF THE CALL

Mechanism of Injury (MOI)

Identifying the type of motor-vehicle collision also

The mechanism of injury is what causes an injury (e.g.. a rapid deceleration causes the knees to strike the dash of a car: a fall on ice causes aprovides twisting important force to information on potential injury patterns. the ankle). Certain are considered "common" to particular situations. InjuKnowing the injuries mechanism of injury is very important to riesyou toinbones and joints are usually associated falls and vehicle collisions; your initial assessment of the scene and thewith patient. burns are common to fires and explosions; penetrating soft-tissue injuries can be Head-on collisions. associated with terms, gunshot andofso on. is what In simple thewounds, mechanism injury • These have a great potential for injury to all parts caused the injury. Certain injuries are considered “common” of the body. Two types of injury patterns are likely: the Even if you cannot determine exact and injury theare patient has up-and-over sustained, knowto particular situations. Injuriesthe to bones joints pattern and the down-and-under pattern. In ingusually the mechanism of injury allow you to predict various injury patterns. For associated with falls may and vehicle collisions; burns the first pattern, the patient follows a pathway up and over example, in many situations you willpenetrating immobilizesoft-tissue the patient's spine because the commonly striking the head on the are common to fires and explosions; the steering wheel, mechanism ofbe injury, such with as a forceful blow, is frequently with (especially spinal injuries can associated gunshot wounds, and so on. associated windshield when he was not wearing a seatbelt), injury. You do not need to know that the patient's spine is actually injured: youneck injuries. Additionally, the patient causing head and youtreat cannot determine Knowing the exact injury thepatient hasmay assumeEven il is if and accordingly. that the fallen should tell and abdomen on the steering wheel, strike the chest patient has sustained, knowing mechanism of injury you to check for an injured arm the or leg. causing chest injuries or breathing problems and internal may allow you to predict various injury patterns. organ injuries. In the second pattern. the patient’s body Motor- Vehicle Collisions Identifying the mechanism of injury is very important follows a pathway down and under the steering wheel, many situations you will immobilize patient’s when In dealing with motor-vehicle collisions.theFor example, a collapsed or benthis knees on the dashboard, causing knee, typically striking spine because mechanism injury, suchhas as asuffered forceful a chest-wall steering columnthe suggests thatofthe driver injury with leg, and hip injuries. blow, isrib frequently with spinal injury. You do not blood-spattered windpossible or evenassociated lung or heart damage. A shattered, needpoints to know patient’s of spine is actuallyor injured; shield tothat thethe likelihood a forehead scalp you laceration and possibly a already assume this andthat treatmay it accordingly. Rear-end collisions severe blow to the head have caused a head or spinal injury. • These are common causes of neck and head injuries. Newton’s Law of Motion also has something to say about Motor vehicle collissions -- Identifying The law of inertia—that a body in motion the willmechanism remain in motion unless acted a body that is not moving -- that a body at rest will remain of injury very important whenbeing dealingstopped with motor-vehicle upon by anis outside force (e.g., by striking something)—explains at rest unless collisions. A collapsed or bentcollisions steering column why there are actually three involvedsuggests in eachthat motor-vehicle crash.acted The upon by an outside force (such as being pushed jerked). thecollision driver has suffered a chest-wall with possible rib collision first is the vehicle striking injury an object. The second is worhen the This explains or evenbody lung or heartthe damage. A shattered, blood-spattered patient's strikes interior of the vehicle. The third collision occurs whenwhy neck injuries are common in a rear-end collision—the head remains still as the body is to the strike likelihood of a forehead or body. scalp thewindshield organs ofpoints the patient surfaces within the pushed violently forward by the seat, extending the neck laceration and possibly a severe blow to the head that may backward.informaHere you will realize the importance of a properly have caused injury. collision also provides important Identifying thea head type or of spinal motor-vehicle fitted headrest protecting the head and the neck in case of tion on potential injury patterns: collisions. The law of inertia — Isaac Newton once said that a body in motion will remain in motion unless acted upon Side-impact collisions (“T-bone”) by an outside force . This explains why there are actually • These collision* have other injury patterns. The head three collisions involved in each motor-vehicle crash. The tends to remain still as the body is pushed laterally, causing first collision is the vehicle striking an object. The second injuries to the neck, The head, chest, abdomen, pelvis, and collision is when the patient’s body strikes the interior of the thighs may he struck directly causing skeletal and internal vehicle. The third collision occurs when the organs of the injuries. patient strike surfaces within the body. 168

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PREHOSPITAL EMERGENCY CARE

UNIT 2 DAY 7

Rollover collisions

FUNDAMENTALS OF EMT PRACTICE

Injuries involving motorcycles and all-terrain vehicles also have the potential to • These are potentially most because of in be serious.the These vehicles offerserious the Operator and passengers little protection the event of a collision. Determine whether the patient was wearing a helmet the potential for multiple impacts. Rollover collisions that offered some protection from head injury. Also attempt to determine whether the patient w as ejected. In some cases, the operator will be thrown from the and strike and severely hips, thighs, frequently cause ejection ofbikeanyone whoinjureishisnot wearing a or legs. seatbelt. Expect any type of serious patterns. SAMPLESinjury OF ACTUAL ACCIDENTS

UNIT UNIT 22 DAY DAY 77

(Courtesy of Lifeline Ambulance Rescue Inc Crew)

Rotational impact collisions

• These involve cars that spin after they are struck. The initial impact often causes subsequent impacts -- the spinning vehicle strikes another vehicle or a tree. As in a rollover collision, this can cause multiple injury patterns.

FUNDAMENTALS FUNDAMENTALS OF OF EMT EMT PRACTICE PRACTICE SAMPLES OF ACTUAL ACCIDENTS From Lifeline 16-911 Ambulance Crew

“

An important aspect of mechanism of injury determination is to find out where the patient was sitting in the vehicle and if he was wearing seatbelts. Note any deformities in the steering wheel, dashboard, pedals, or other structures within the vehicle. ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

You will often be able to observe important clues regarding mechanism of injury before you even exit the ambulance. At a head-on collision, for instance, you can anticipate up-and-over or down-and-under injury patterns for a driver who remains in his car and multiple injury patterns for a driver who is thrown from his car. For both patients, anticipate external injuries from the collision of the body with auto interiors and pavement, and internal injuries from collision of organs with the interior of the body as well as““from external blunt-force or penetrating trauma. When a patient appears to have been the driver of a vehicle, look for damage to the windshield, steering wheel, dashboard, and pedals when you are able to do a close-up inspection. You should also observe for damage to other interior surfaces, which might indicate there were additional passengers/ patients. Injuries involving motorcycles have the potential to be serious. These vehicles offer the driver and passenger little protection in the event of a collision. Determine whether the patient was wearing a helmet that offered some protection from head injury. Also attempt to determine whether the patient was ejected. In some cases, the operator will be thrown from the bike and severely injure his shoulders, hips, thighs, or legs.

² ²Limmer Limmer(Brady) (Brady) ³ ³Pollack, Pollack,(AAOS) (AAOS) ⁴ ⁴NHTSA NHTSA

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EXAMPLES OF VEHICLES FROM DIFF UNIT FROM 2 EXAMPLES OF VEHICLES DIFFERENT ACCIDENTS (Courtesy of AAP—taken from AAP C FUNDAMENTALS OF EMT PRACTICE FUNDAMENTALS OF EMT PRACT UNIT 2 EXAMPLES OF VEHICLES FROM DIFFERENT ACCIDENTS DAY 7 FUNDAMENTALS OF EMT PRACTICE SCENE SIZE-UP UNIT 2 Day 7 (FUNDAMENTALS Courtesy ofTHE AAP—taken from AAP Compound) FUNDAMENTALS OF EMT PRACTICE OF EMT PRACTICE DAY DAY77

(Courtesy of AAP—taken from AAP Compound)

EXAMPLES OF VEHICLES FROM DIFFERENT ACCIDENTS Courtesy of the Automobile Association Philippines

XAMPLES OFOF VEHICLES ACCIDENTS EXAMPLES OF VEHICLES FROM DIFFERENT ACCIDEN EXAMPLES VEHICLESFROM FROM DIFFERENT DIFFERENT ACCIDENTS (Courtesy of AAP—taken from AAP Compound) EXAMPLES OF (Courtesy of of AAP—taken AAP AAP—takenfrom from AAP Compound) Compound) (Courtesy EXAMPLES OFVEHICLES VEHICLESFROM FROMDIFFERENT DIFFERENTACCIDENTS ACCIDENTS (Courtesy from AAP Compound) AAP—taken from AAP Compound) (CourtesyofofAAP—taken

“ “

“

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mmer (Brady)

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PREHOSPITAL EMERGENCY CARE ² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

FERENT ACCIDENTS

Compound) TICE

NTS

Fall

A falls is another cause of injury where the extent and pattern of damage may be determined by its characteristics. Important factors to consider are the height from which the patient fell, the surface the patient fell onto, the part of the patient that hit the surface, and anything that interrupted the fall. In a fall, injury to the part of the body that comes in contact with the ground or another hard surface is only the beginning of the trauma experienced by the patient. The force is also transmitted to adjoining parts of the body. Think of a person who dives head first into a shallow body of water and strikes his head. Although the head will be injured, the force travels on to the cervical and thoracic spine, very possibly resulting in severe spinal cord injury and paralysis. Similarly, when a patient jumps from a height and lands squarely on his feet, there is trauma to the feet but

also to the ankles, legs, and even the pelvis. Always assess along the path of the energy. It is likely that you will find additional injuries. Experts say that a fall of greater than 20 feet for an adult or greater than 10 feet for a child under age 15 or more than two to three times the childâ&#x20AC;&#x2122;s height, is considered to be a severe fall for which transport to a trauma center is recommended. This is a reasonable guide, but it doesnâ&#x20AC;&#x2122;t guarantee a resulting injury or rule out injury if the fall is less than the distance. It is important to look at all factors at the scene in combination with the patientâ&#x20AC;&#x2122;s complaint, vital signs and your physical examination findings. When in doubt, assign the patient a high priority for rapid packaging and prompt transport.

Penetrating Trauma

Penetrating trauma, or injury caused by an object that passes through the skin or other body tissue, has characteristics that may help in determining the extent of injury. These wounds are classified by the velocity, or speed, of the item that caused the injury. Low-velocity items are those that are propelled by hand, such as knives. Low-velocity injuries are usually limited to the area that was penetrated. Remember that there can be multiple wounds or the blade may have been moved inside the patient, so there can be damage to multiple vital organs. Medium-velocity wounds are usually caused by handguns and shotguns. Some forcefully propelled items such as an arrow launched from a compound bow or a ballistic knife will also cause greater velocities than the same items propelled by hand.

Blunt-Force Trauma Blunt-force trauma is injury caused by a blow that strikes the body but does not penetrate the skin or other body tissues. Example is when one is struck by a baseball bat or thrown against a steering wheel. The energy from a blunt-force blow will travel through the body, often causing serious injury to, and even rupture of internal organs and vessels. The resulting compromise of body functions, hemorrhage, or spillage of organ contents into the body cavity may have more severe consequences for the patient than a penetrating injury. Yet signs of blunt-force trauma are often subtle and easy to overlook. Bullets propelled by a high-powered or assault rifle travel at a high velocity. Medium-and high-velocity injuries can cause damage almost anywhere in the body.

Dalawang paraan puwedeng makasira ng bahagi ng katawan ang bala mula sa isang baril. Ang unang paraan ay ang pagkasira mula mismo sa pumasok na bala. Sinisira ng bala ang lahat ng bagay na dinadaanan niya. May mga pagkakataon na nagkakadurug-durog ang bala pagpasok sa katawan ng tao at ang maliliit na bahagi nito ay tumatama at sumisira sa lahat ng tinatamaan nito. Ang ikalawang paraan na naninira ang bala ay sa pamamagitan ng pressure o cavitation. Sa pagpasok ng bala sa katawan, lumilikha ito ng pressure wave na mas malaki pa sa sukat ng bala. Sinsira ng pressure wave na ito ang lahat ng nasa dadaanan niya.

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Unit 1

Day 7

THE SCENE SIZE-UP

NATURE OF ILLNESS Nature of illness— This is the reason why EMS was called. What is or may be wrong with the patient medically? Obtaining information can be accomplished with the aid of the following sources: 1. Patient— 2. 3.

a. b. c. d.

Response to Danger: PLAN

Wear safe clothing Prepare your equipment Carry portable radio whenever possible Decide on safety roles

The primary source of information provided UNIT 2 that he/she is conscious and oriented. FUNDAMENTALS OF EMT PRACTICE DAY 7 Family and bystanders—In cases of an unconscious Response to Danger: OBSERVE UNIT 2 patient, they can also provide important information a. Survey scene on approach OF EMT PRACTICE FUNDAMENTALS DAY 2 7 b. Don’t announce arrival – turn UNIT about the patient and his/her condition. offEMT lights and siren Response to Danger: OBSERVE OF FUNDAMENTALS PRACTICE DAY 7 c. a.Drive Survey scene on approach few feet past residence so you can see front and The scene— This will tell or give you an idea of what b. don’t announce arrival – turn off lights and siren sides to feet happened. Upon your scene size-up, be observant and c. drive few past residence so you can see front and sides Response Danger: OBSERVE d. a. take note of possible clues that are pertinent to your d.Violence violence Survey scene on approach Response to Danger: OBSERVE e.Alcohol alcohol or or drug use don’t announce arrival – turn off lights and siren e. b. drug use patient’s condition. a. Survey scene approach f. weapons drive few feeton past residence so you can see front and sides f. c.b. Weapons don’t announce arrival – turn off lights and siren g. violence family members d. drive few feet past bystanders e.Family alcohol ormembers drug useresidence so you can see front and sides g. c.h. d.perpetrators violence weapons h. i.f.e. Bystanders alcohol or drug use Number of Patients j.g.pets family members weapons i. f.h.Perpetrators bystanders a. How many patients are present? family members perpetrators React to Danger: Three R’s j. i.g. Pets h. bystanders b. Do you have sufficient resources on hand to care for j. pets i. perpetrators all patients? RETREAT j. pets

Other Additional Resources

a. Does the situation require specialized resources • Fire • Technical rescue • Hazardous material response

React to Danger: Three R’s React to Danger: Three R’s RETREAT RETREAT

React to Danger: Three R’s RETREAT

Scene Safety

a. EMS is not usually a dangerous profession. b. Being aware of potential dangers is always a priority. c. Determining scene safety will be the most important decision on any call. d. Potential safety threats at the scene: “ • Hazardous materials incidents • Terrorist incidents • Rescue operations “ • Violence “ • Weapons

RADIO

RADIO RADIO

REEVALUATE

Staging

REEVALUATE

a. If it is not safe to approach the scene, stop in a secure area away from the scene. b. Wait until you are cleared to enter by appropriate authorities.

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² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

REEVALUATE REEVALUATE

Acts of Violence

UNIT UNIT2 2 DAY DAY7 7

Another significant danger you will face as am EMT is violence. Crime risks vary, but it is certain that you will be exposed to more dangerous situations than a few years ago. Shootings and terrorist incidents are now on the minds of EMS providers worldwide. So be careful always.

Specific Techniques to avoid physical FUNDAMENTALS FUNDAMENTALS OF OFEMT EMTPRACTICE PRACTICE violence include:

1. BEST = Don’t be there in the first place. Wait for an “all clear” from law Specific Specific Techniques Techniquestotoavoid avoidphysical physicalviolence violenceinclude: include: enforcers. 1. 1. BEST BEST = Don’t = Don’t bebe there there in in thethe first first place place ( wait ( wait forfor anan “all“all clear” clear” from from Law Law 2. Immediate retreat. Enforcement Enforcement 3. Wedging equipment in a doorway as 2. 2. immediate immediate retreat retreat Although a majority of the calls you will receive would go by without any 3. 3. wedging wedging equipment equipment in in a doorway a doorway asas you you retreat retreat you retreat. 4. 4. using using anan unconventional unconventional path path to to retreat retreat incident, you must still be conscious of dangers from many sources, including 4. Using an unconventional 5. 5. anticipating anticipating the the moves moves of of thethe aggressor aggressorpath to other human beings. You probably envision violence as occurring at bar fights 6. 6. overturning overturning objects objects in in the the path path of of the the attacker attacker retreat. 7. 7. Having Having a pre-planned a pre-planned safety safety zone. zone. or on the street, but domestic violence (those that happen in the home) is also a 5. Anticipating the moves of the Cover Cover VS.VS. Concealment Concealment and and thethe Difference Difference cause for concern. aggressor. UNIT UNIT22 1.6.1.Concealing Concealing yourself yourself is is placing placing your your body behind behind anof an object object hide Overturning objects inbody the path thethatthatcancanhide you you from from view; view; concealment concealment doesn’t doesn’t stop stop projectiles. projectiles. FUNDAMENTALS FUNDAMENTALS OF OF EMT EMT PRACTICE PRACTICE Protection from violence is as important as protection from the dangers DAY DAY77 2. 2.taking attacker. taking cover cover is is finding finding a position a position that that both both hides hides and and protects protects your your body body at a vehicle collision. As an EMT. you should never enter a violent situation from projectiles projectiles 7. from Having a pre-planned safety zone. to provide care. Safety at a violent scene requires a careful size-up as you approach. Just as a downed wire signals danger at a collision site, there are Specific SpecificTechniques Techniquestotoavoid avoid physical physicalviolence violenceinclude: include: CONCEAL CONCEAL many signals of danger from violence that you may observe as you approach CONCEAL 1.1.BEST BEST= =Don’t Don’tbebethere thereininthe thefirst firstplace place( wait ( waitforforanan“all “allclear” clear”from fromLaw Law the scene, such as: Enforcement Enforcement

• Fighting or loud voices.

If you approach a scene and see or hear fighting, threatening words or actions, or the potential for fighting, there is a good chance that the scene will be a danger to you.

• Weapons visible or in use. Any time you observe a weapon, you must use an extreme amount of caution. The weapon may actually be in the hands of an attacker or simply in sight. Weapons include knives, guns “ “ and other items that may be used to inflict harm.

• Signs of alcohol or other drug use. When alcohol or other drugs are

in use. a certain unpredictability exists at any scene. It will not take long for you to observe unusual behavior from a person under the influence of one of these substances. This behavior may result in violence toward emergency personnel at the scene. Also, there are hazards associated with the drug culture, such as street violence and the presence of contaminated needles.

• Unusual silence. Emergencies are usually active events. A call that is “too quiet” should raise your suspicions. Although there may be a good reason “ “ for the silence, extra care should be taken.

• Knowledge of prior violence. If you or a member of your crew has

been to a particular location for calls involving violence in the past, extra caution must be used on subsequent calls to the same address. Neighbors may sometimes volunteer information about previous incidents

2.2. immediate immediate retreat retreat 3.3. wedging wedging equipment equipment inin a doorway a doorway asas you you retreat retreat 4.4. using using anan unconventional unconventional path path toto retreat retreat 5.5. anticipating anticipating the the moves moves ofof the the aggressor aggressor 6.6. overturning overturning objects objects inin the the path path ofof the the attacker attacker 7.7. Having Having a pre-planned a pre-planned safety safety zone. zone.

Cover Cover VS. VS. Concealment Concealment and and the the Difference Difference

1.1.Concealing Concealingyourself yourselfis isplacing placingyour yourbody bodybehind behindananobject objectthat thatcan canhide hide you you from from view; view; concealment concealment doesn’t doesn’t stop stop projectiles. projectiles. 2.2.taking takingcover coveris isfinding findinga aposition positionthat thatboth bothhides hidesand andprotects protectsyour yourbody body from from projectiles projectiles

CONCEAL CONCEAL COVER COVER Cover vs. Concealment and the Difference 1. Concealing yourself is placing your body behind an object that can hide you from view. Concealment doesn’t stop projectiles. 2. Taking cover is finding a position that both hides and protects your body from projectiles ² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

COVER COVER

COVER

Whether the call is residential or in the street, observe the scene for the signs of danger listed previously and any others you may find. This brief danger assessment may be all that is required to prevent harm to you or your crew during the call. If you suspect a violent situation, retreat and request law enforcement back up. just like in a wildfire, as you approach the scene have a “safety zone” that you can retreat to. ² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

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A crime scene is the location where any part of criminal act was committed. All entry and exit routes from the area where crime was committed is also a part of the crime scene. THE SCENE SIZE-UP Unit 1 Day 7

Crime Scenes

A crime scene is the location where any part of a criminal act was committed. All entry and exit routes from the area where a crime was committed is also a part of the crime scene. The coverage

The coverage

1. Insight of the nurses and criminal liability 2. Forensics and the health care provider Physical Injuries Sexual crimes Death 3. Nurse in the court 4. Like any other citizen, a nurse may incur criminal liability or subject herself to criminal prosecution. 6. “Ignorance of the law excuses no one”

Physical Injuries 1. Insight of the Nurses and criminal liability 1. Classification wounds 2. Forensics and the health careofprovider • Abrasions Physical Injuries • Contusions • Hematoma Sexual crimes • Lacerations Death • Stab wounds wound 3. Nurse in the court •• Incised Gunshot wounds 4. Insight of the Nurses and criminal liability a. Location, important b. Is it a defense wound? 5. Like any other citizen, a nurse may incur criminal liability or subject herself to i. Chop Wounds ii. Incised Wounds criminal prosecution. 6. Insight of the Nurses and criminal liability— “Ignorance Suicide of the law excuses no one” 1. “The hallmark of self infliction Electrocution is repetition.” 2. Usually grouped incisions, Physical Injuries 1. Low voltage- 110 to 220 V

174

1. Classification Of  Abrasions  Contusions LIFELINE Hematoma PREHOSPITAL EMERGENCY CARE  Lacerations  Stab Wounds

2. High voltage- high tension wires 7,000 V Wounds 3. Death: ventricular fibrillation 4. Death: electro-thermal injury

parallel. 3. Usual site: throat and wrist. 4. “Trial or tentative cuts” 5. Homicidal cut throat is devoid of tentative cuts and is severe.

Evidence Preservation 1. Patient care is FIRST priority of ALL responding agencies 2. Initial Approach • Minimum number of people necessary (one) • Minimum amount of equipment necessary • Minimum amount of contact required 3. Fundamental Principle • It is impossible to be on a crime scene without: a. Leaving evidence of yourself on scene b. Taking evidence of scene with you

Evidence

1. Anything that can be used to connect: • A victim to a suspect • A suspect to a victim • A suspect to a crime scene

2. Types:

• Witness • Physical • Trace

3. Time of Death

• Factors used in estimating time of death a. Livor mortis (post mortem lividity) i. Reddish, purplish blue color ii. Begins in 30 mins iii. Intensifies over time iv. May result in post mortem petechiae v. It’s not a contusion vi. Average corpse cools down 1 degree every hour vii. Full effect 6 hours b. Rigor mortis (muscle stiffening) i. depletion of ATP ii. Begins in 2 hrs iii. Jaw, face, arms, legs iv. Full rigor in 6-12 hrs v. Lost due to decomposition vi. Usually disappear after 24 hrs vii. Cadaveric spasm-rare c. Algor mortis (body temp) i. 35.6°C - 38.2°C ii. Higher in girls iii. Infants cool faster iv. Obese cools at lower rate d. Stomach contents i. Gastric emptying varies from person to person, amount of meal and time of the day ii. Half gastric emptying time: 4 hrs iii. Stress will delay digestion e. Environmental factors - Insect activity- from egg stage to adult stage.

4. Wound

• Often matched to weapons • Provides clues to the victims injuries, characteristic of the suspect and position of the suspect to victim • Dynamics of stab wounds: a. Weber and Milz i. Speed of stabs i) Males: * 6.14 m/s on dominant hand * 5.27 m/s on non-dominant hand ii) Females: * 4.16 m/s on dominant hand * 3.68 m/s on non-dominant hand ii. Number And Distribution Of Wounds: i) Number of stabs shows a certain correlation with the gender of the perpetrator a) Female: fewer stab wounds on average than in homicides that were committed by male perpetrators. b) Can inflict only one singular stab to their victim esp. if the victim is a man ii) Karlsson a) Singular stabs occurred mostly in the course of arguments between intoxicated men whereas women who killed men usually inflicted two to nine stabs iii) Anatomical distribution: most are located on the thorax and neck a) (Bajanowski et al) injuries were located on the anterior left side of the trunk in 50 % of the cases b) (Bajanowski et al) singular fatal stabs, the precordial region is strongly over represented iv) In both sexes, the most common stabbing sites are the chest and the neck

5. Causes Of Death:

• Stab injuries of the trunk a. minor external bleeding but with most of the blood accumulating in the thoracic and abdominal cavity b. By a shift in the soft tissue layers, wound tracks may close, in most cases, only partially hence minor traces of blood on clothing despite massive injuries • Stab or cut wounds neck a. Aspiration of blood b. Air embolism • Less frequent cause of death: a. Cardiac tamponade b. Failure of central regulatory processes

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Unit 1

Day 7

THE SCENE SIZE-UP

Crime Scenes R-E-S-P-O-N-D R (RESPOND) • General observations on the way to the scene. • Mental notes – anything out of place? • SAFETY is number one consideration.

E (EVALUATE) • Safety

a. Calls in progress

• Factors

•

a. Suspect, victim and witness b. BLS, HAZMAT, SWAT c. Weapons d. Fire, Gas, Electric Call – Not in progress, already at the scene a. Ask for assistance b. Limit access, one way IN/OUT (people and vehicle) c. PPE d. Take notes – who, what, when, where, when

S (SECURE)

P (PROTECT) • Safeguard items in the scene

1) Room in which the patient was treated 2) Vehicle 3) Personal items 4) No movement of dead body until authority arrives

O (OBSERVE) i. Basic factors:

1) Time of call, arrival 2) Weather/temperature 3) Doors open or locked 4) Lights on or off 5) Position of patient

N (NOTIFICATIONS) D (DOCUMENT)

• Establish perimeter

1) Tape/rope 2) Be aware of: a) Footprints b) Tire prints c) Physical evidence (i.e. blood) d) Suspect escape route

• Establish log

1) Anyone, past or present 2) Turn over to Law enforecemnt when they arrived 3) Include in log: a) Names b) Dates c) Agency d) Time entered and exited e) Reason entered

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WARNING: The photos that you see on this section are actual shots taken from a real crime scene during our ambulance crew duty. For confidentiality purposes, we will not reveal the name of the patients and the actual place where this incident happen.

“

EXAMPLE OF A CRIME SCENE UNIT 2 DAY 7

Endorsement time was 0535H, a report from a motorist called the Lifeline 16-911 marshall and informed the office to deploy an ambulance to the site. Upon arrival, a bloody scene of a mother and a daughter was found on a darkened area around an electric post. Injuries noted were both severe blunt injury to the head. Both heads cracked open on both occipital area. This incident was aired in a television news. The story was a male partner walked with FUNDAMENTALS OF EMT PRACTICE the two victims then found a large and sharp rock, and bluntly hit both the victims on the head. The blood-stained rock was still on the area where the victims were found. It was used by scene of the crime operatives (SOCO) as evidence against the assailant.

UNIT 2 DAY 7

FUNDAMENTALS OF EMT PRACTICE Source: Photos and story contributed by Ross Viloria Lifeline 16-911 Ambulance crew

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² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

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Day 7

THE SCENE SIZE-UP

EMS at Crime Scene The goal of performing EMS at crime scenes is to provide high quality patient care while preserving evidence. NEVER jeopardize patient care for the sake of evidence. However, do not perform patient care with disregard for the criminal investigation that will follow. Be aware you may have to justify your actions to the police if necessary.

Your Duty as an EMT::

1. Take pictures before treatment. 2. Take notes, measure and draw. 3. Preserve the evidence collected. 4. Call the police. 5. All deaths are medico-legal case. 6. Pre-hospital personnel shall follow the direction of law enforcement with respect to crime scene management. The direction should not prevent nor detract from quality care. The following guidelines should be followed: a. Parking of EMS vehicles provides access for EMS personnel, but with consideration for the crime scene. b. Do not run over bullet shell casings. c. Do not destroy evidence such as tire tracks, foot prints, or broken glass. d. Consider wearing gloves for all activities at a crime scene including those not directly involved with patient care. e. Entry to the crime scene should be made with the minimum number of personnel necessary to access and provide care to the patient(s). f. Do not send in multiple BLS first responders, ALS first responders and ambulance crew if it is likely to be a presumption of death. g. Entry to and exit from the crime scene should be accomplished by the same route. h. Do not walk through fluids (blood) on the floor. Care should be taken not to disturb any physical evidence. Physical evidence can be as small as a single hair. ii. Do not move or touch anything unless it is necessary to do so for patient care. iii. Observe and document any items moved. iv. Notify law enforcement of, and document, any items removed from the scene (impaled object, bottles, patient belongings). v. Weapons should not be moved unless they pose an immediate threat. i. Removal of patient clothing should be kept to a minimum. i. Do not cut through bullet holes or knife holes. ii. Clothing and all personal articles of the patient are to be left in the possession of law enforcement personnel. Do not discard anything. 178

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a) Put wrappers and other disposable “trash” which accumulates as patient care is rendered. b) Do not clean or disturb a patient’s hands when involved with a firearm. j. Patients who meet the “obvious death” criteria do not require confirmation of asystole, or any manipulation of the body. These include: i. Decapitation. ii. Incineration of 90% or more of the total body surface area. iii. Decomposition or putrefaction. iv. Transection of the torso. v. Dependent lividity with rigor. vi. Patients total incineration of torso and/or head. vii.Decomposition. viii.Total separation of vital organs from body or total destruction of these organs accompanied by no detectable pulse or respirations. ix. Any other injury not compatible with life in a pulseless apneic patient. k. Patient who meet the criteria for withholding resuscitative efforts should be assessed using the minimum number of EMS personnel. l. It is important to realize that law enforcement personnel have the authority to presume death. If death has been presumed by a law enforcer, medical confirmation procedures do not need to be performed by pre-hospital providers unless requested. m. Every effort to cooperate with law enforcers should be made. In the event of a disagreement with law enforcers, you should document the problem and refer the matter to your superior for follow-up and/or action. n. In the event that you discover a crime scene, or are at a crime scene without law enforcement, an immediate request for law enforcement shall be made. o. Laundering of the scene at the completion of the investigation is not routinely in the scope of responsibility for the EMS or fire agencies and therefore these requests should be referred to the appropriate resources for completion of scene management.

Approaching the Scene 1. Your safety strategy begins as soon as you are dispatched on a call. 2. NEVER follow police units to a known crime scene 3. Rather than risk becoming injured or killed, err on the side of safety. 4. Stage well away until approved to enter the scene by law enforcers. 5. Never approach the scene until you are advised that the scene is secure by dispatch or in-person by law enforcers. 6. Approach potentially unstable scenes single file. 7. Hold a flashlight to the side of your body, not in front of it. 8. Try not to silhouette your approach to a potential crime scene. Walk to the side of a light source.

Clandestine Drug Lab – Take these actions: • Leave the area immediately • Do not touch anything • Never stop any chemical reactions already in progress • Notify dispatch/police • Initiate ICS and HAZMAT procedures • Consider evacuation of the area

Potentially Dangerous Situations

• No open flame or sparks

1. Undispatched sudden roadway encounters: a. Think about possible criminal activities. 2. Calls involving mentally unstable individuals 3. Murders, assaults, robberies 4. Dangerous crowds 5. Known gang residence 6. Drug-related crimes 7. Clandestine drug laboratories 8. Domestic violence 9. Calls of “unknown medical condition”

Dangerous Crowds and Bystanders 1. Shouts or increasingly loud voices 2. Pushing or shoving 3. Hostilities toward anyone 4. Rapid increase in the crowd size 5. Inability of law enforcers to control bystanders 6. Circling or crowding of first responders 7. Can be as few in number as a single family unit.

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TODAY you will learn about vital signs and how to get them. The first question you have to ask yourself is, how vital are vital signs? What do they really tell you as a future EMT? Vital signs are an important component of patient care. They tell you which treatment protocols to follow. They also provide critical information needed to make life-saving decisions, and confirm feedback on treatments performed. Accurate, documented vital signs are a very important part of the Emergency Medical Service. In this chapter, you will learn five components of a set of vital signs that include blood pressure, pulse rate,

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respiratory rate, temperature and even blood oxygen level. As an EMT, you would assess and retain these information to make treatment decisions. You would regularly monitor these signs as a feedback mechanism of the bodyâ&#x20AC;&#x2122;s response to treatment. It is crucial, therefore, that you master the use of the devices to monitor these vital signs. And this and more will be discussed in this chapter. Since vital signs are truly vital, we cannot overemphasize the importance of knowing how to measure these signs. Failing to do so would jeopardize your decisions as an emergency healthcare provider.

DAY

Vital Signs and Monitoring Devices Pulse Rate and Quality Respiratory Rate and Quality Skin and Pupils Temperature Blood Pressure and Blood Glucose

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VITAL SIGNS AND MONITORING DEVICES LEARNING OBJECTIVES Once you complete this topic, you as an aspiring EMT will know the importance of the human body’s vital signs and how to obtain them. These vital signs -- pulse rate, respiratory rate, blood pressure and the temperature, including blood glucose -- are measured using various monitoring devices. This chapter will teach you how to document the obtained vital signs on a pre hospital care report.

VITAL SIGNS Vital signs are outward signs of what is going on inside the body. They include pulse, respiration, skin color, temperature, and condition (plus capillary refill in infants and children), pupils, and blood pressure. Although it is not considered to be a vital sign, many EMS providers include oxygen saturation with their consideration of the vital signs. Evaluation of these indicators can provide you. as an EMT with valuable information. The first measurements you obtain are called the baseline vital signs. You can gain even more valuable information when you repeat the vital signs and compare them to the baseline measurements. This allows you and other members of the patient’s healthcare to learn to see trends in the patient’s condition and to respond appropriately. Another sign that gives important information about a patient’s condition is menial status. Although it is not considered one of the vital signs, you should assess the patient’s mental status whenever you take the vital signs.

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Gathering the Vital Signs When you begin to assess a patient, some things are obvious or easy to discover. The most important part of assessment is the chief complaint, the reason the patient called for an ambulance. Usually, the patient will tell you his complaint. Other parts of assessment that are usually apparent as soon as you see and talk to the patient are age, sex, and general alertness. However, not all parts of your assessment are so obvious or so easy to find out. The vital signs are major components of assessment that will take a few minutes to complete. Vital signs are gathered on virtually every patient. Occasionally, a patient will be so seriously injured or ill that you are not able to get this information because you are too busy treating immediate threats to life. This is the exception, however. The vast majority of patients you will encounter as an EMT should have an assessment that includes vital sign measurement. If you do not get this information, you may remain unaware of important conditions or trends in patient conditions that require you to provide particular treatment in the field or prompt transport to a hospital. Where do vital signs fit into the sequence of patient assessment? After the primary assessment to find and treat immediate life threats, you will conduct a more thorough assessment that includes a secondary assessment. Vital signs will be obtained during this part of the assessment process.

Sa chapter na ito ay matututunan mo ang kahalagahan ng pagkuha ng vital signs gaya ng pulso, dalas ng paghinga, presyon ng dugo, temperatura, at iba pa. Ang mga vital signs na ito ang magsasabi sa iyo ng kondisyon ng pasyente.

It is essential that you record all vital signs as you obtain them, along with the time at which you took them.

PREHOSPITAL EMERGENCY CARE

PULSE The pumping action of the heart is normally rhythmic, causing blood to move through the arteries in waves, not smoothly and continuously at the same pressure like water flowing through a pipe. A fingertip held over an artery where it lies close to the body’s surface and crosses over a bone can easily feel the characteristic “beats” as the surging blood causes the artery to expand. What you feel is called the pulse. When taking a patient’s pulse, you are concerned with two factors: rate and quality.

NORMAL PULSE RATES (BEATS PER MINUTE, AT REST) ADULT

60 to 100

ADOLESCENT 11 to 14 years

60 to 105

SCHOOL AGE 6 to 10 years

70 to 110

PRESCHOOLER 3 to 5 years

80 to 120

TODDLER 1 to 5 years

80 to 130

INFANT 6 to 12 months

80 to 140

INFANT 0 to 5 months

90 to 140

NEWBORN

120 to 160

Pulse Quality

Pulse Rate The pulse rate is the number of beats per minute. The number you get will allow you to decide if the patient’s pulse rate is normal, rapid, or slow. Pulse rates vary among individuals. Factors such as age, physical condition, degree of exercise just completed, medications or other substances being taken, blood loss, stress, and body temperature all have an influence on the rate. The normal rate for an adult at rest is between 60 and 100 beats per minute. Any pulse rate above 100 beats per minute is rapid, whereas a rate below 60 beats per minute is slow. A rapid pulse is called tachycardia. In contrast, a slow pulse is called bradycardia. An athlete may have a normal at rest pulse rate between 40 and 50 beats per minute. This is a slow pulse rate, but it is certainly not an indication of poor health. However, the same pulse rate in a nonathletic or elderly person may indicate a serious condition. You should be concerned about the typical adult whose pulse rate stays above 100 or below 60 beats per minute. In an emergency, it is not unusual for this rate to temporarily be between 100 and 140 beats per minute, If the pulse rate is higher than 150, or if you take a patient’s pulse several times during care on-scene and find him maintaining a pulse rate above 120 beats or below 50 beats per minute, consider this a sign that something may be seriously wrong with the patient and transport as soon as possible.

Two factors determine pulse quality: Rhythm and force. Pulse rhythm reflects regularity. A pulse is said to be regular when intervals between beats are constant. When the intervals are not constant, the pulse is irregular. You should report and document irregular pulse rhythms. Pulse force refers to the pressure of the pulse wave as it expands the artery. Normally the pulse should feel as if a strong wave has passed under your fingertips. This is a strong or full pulse. When the pulse feels weak and thin, the patient has a thready pulse. Many disorders can be related to variations in pulse rate, rhythm and force.

PULSE QUALITY

SIGNIFICANCE/POSSIBLE CAUSES

Rapid, regular, and full

Exertion, fright, fever, high blood pressure, first stage of blood loss

Rapid, regular, and thready

Shock, later stages of blood loss

Slow

Head injury, drugs, some poisons, heart problems, lack of oxygen in children

No pulse

Cardiac arrest (clinical death)

Infants and Children: A high pulse in an infant or child is not as great a concern as a low pulse. A low pulse may indicate imminent cardiac arrest.

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Pulse rate and quality can be determined at a number of points throughout the body. During the determination of vital signs, you should initially find a wrist pulse in patients one year of age and older. This is the radial pulse, named for the radial artery found on the lateral (thumb) side of the forearm. In an infant who is one year old or less, you should find the brachial pulse in the upper arm rather than the radial pulse. If you cannot measure the pulse on one arm. try the pulse of the other arm. When you cannot measure the radial or brachial pulse, use the carotid pulse, felt along the large carotid artery on either side of the neck. Be careful when palpating a carotid pulse in a patient. Excessive pressure on the carotid artery can result in slowing of the heart, especially in older patients. If you have difficulty finding the carotid pulse on one side, try the other side, but do not assess the carotid pulses on both sides at the same time.

In order to measure a radial pulse, find the pulse site by placing your first three fingers on the thumb side of the patient’s wrist just above the crease (toward the shoulder). Do not use your thumb. It has its own pulse that may cause you to measure your own pulse rate. Slide your fingertips toward the thumb side of the patient’s wrist, keeping one finger over the crease. Apply moderate pressure to feel the pulse beats. If the patient has a weak pulse, you may need to apply greater pressure. But take care—if you press too hard you may press the artery shut. Remember: If you experience difficulty, try the patient’s other arm. Count the pulsations for 30 seconds and multiply by 2 to determine the beats per minute. While you are counting, judge the rhythm and force. Record the information. For example, “Pulse 72, regular and full.” and the time of determination. If the pulse rate, rhythm, or force is not normal, continue with your count and observation for a full 60 seconds.

Ang paghinga ay tinatawag na respiration. Binubuo ito ng isang cycle na nagsisimula sa paghigop ng hangin o inhalation at natatapos sa pagbuga ng hangin o exhalation. Sa pagsusuri ng paghinga ng iyong pasyennte, kailangan mong tingnan ang respiratory rate at respiratory quality.

Respiratory Rate The respiratory rate is the number of breaths a patient takes in one minute. The rate of respiration is classified as normal, rapid, or slow. The normal respiration rate for an adult at rest is between 12 and 20 breaths per minute. Keep in mind that age, sex, size, physical conditioning, and emotional state can all influence breathing rates. Fear or other emotions experienced during an emergency can cause an increase in respiratory rate. However, if you have an adult patient maintaining a rate above 24 (rapid) or below 8 breaths per minute (slow), you must administer highconcentration oxygen and be prepared to assist ventilations.

NORMAL RESPIRATORY RATES (BREATHS PER MINUTE, AT REST) ADULT

12 to 20 ABOVE 24 = Serious BELOW 10 = Serious

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ADOLESCENT 11 to 14 years

12 to 20

SCHOOL AGE 6 to 10 years

15 to 30

PRESCHOOLER 3 to 5 years

20 to 30

TODDLER 1 to 3 years

20 to 30

INFANT 6 to 12 months

20 to 30

INFANT 0 to 5 months

25 to 40

NEWBORN

30 to 50

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Respiratory Quality Respiratory quality is the quality of a patient’s breathing. It may fall into any of four categories: Shallow, labored, or noisy. Normal breathing means that the chest or abdomen moves an average depth with each breath and the patient is not using his accessory muscles (look for pronounced movement of the shoulder, neck, or abdominal muscles) to breathe. How can you tell if breathing is normal? Normal depth of respiration is something you can learn to judge by watching healthy people breathe when at rest. Shallow breathing occurs when there is only slight movement of the chest or abdomen. This is especially serious in the unconscious patient. It is important to look not only at the chest but also at the abdomen when assessing respiration. Many resting people breathe more with their diaphragm (the muscle between the chest and the abdomen) than with their chest muscles Labored breathing can be recognized by signs such as an increase in the work of breathing (the patient has to work hard to move air in and out), the use of accessory muscles. nasal flaring (widening of the nostrils on inhalation), and retractions (pulling in) above the collarbones or between the ribs, especially in infants and children. You may also hear stridor (a harsh, high-pitched sound heard on inspiration), grunting on expiration (especially in infants), or gasping. Noisy breathing is obstructed breathing (when something is blocking the flow of air). Sounds to be concerned about include snoring, wheezing. gurgling, and crowing. A patient with snoring respirations needs to have his airway opened. Wheezing may respond to prescribed medication the patient has and that you may be able to assist the patient in taking. Gurgling sounds usually mean that you need to suction the patient’s airway. Crowing (a noisy, harsh sound when breathing in) may not respond to any treatment you give. The patient who is crowing needs prompt transport—as do all patients with difficulty breathing

RESPIRATORY SOUNDS

POSSIBLE CAUSES INTERVENTIONS

Snoring

Airway blocked/open patient’s airway; prompt transport

Wheezing

Medical problem such as asthma/assist patient in taking prescribed medications; prompt transport

Gurgling

Fluids in airway/suction airway; prompt transport

Crowing (harsh sound when inhaling)

Medical problem that cannot be treated on the scene/prompt transport

Respiratory Rhythm Respiratory rhythm is not important in most of the conscious patients you will see. This is because the regularity of an awake patient’s breathing is affected by his speech, mood, and activity, among other things. If you observe irregular respirations in an unconscious patient, however, you should report and document it. Start counting respirations as soon as you have determined the pulse rate. Many individuals change their breathing rate if they know someone is watching them breathe. For this reason, do not move your hand from the patient’s wrist or tell the patient you are counting the respiratory rate. After you have counted pulse beats, immediately begin to watch the patient’s chest and abdomen for breathing movements. Count the number of breaths taken by the patient during 30 seconds and multiply by 2 to obtain the breaths per minute. While counting, note the rate, quality, and rhythm of respiration. Record your results. For example: “Respirations are 16, normal, and regular.” Then record the time of your assessment.

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SKIN COLOR The color, temperature, and condition of the skin can provide valuable information about your patient’s circulation. There are many blood vessels in the skin. Since the skin is not as important to survival as some of the other organs (like the heart and brain), the blood vessels of the skin will receive less blood when a patient has lost a significant amount of blood or the ability to adequately circulate blood. Constriction (growing smaller) of the blood vessels causes the skin to become pale. For this reason, the skin can provide clues to blood loss as well as a variety of other conditions. The best places to assess skin color in adults are the nail beds, the inside of the cheek, and the inside of the lower eyelids. Tiny blood vessels called capillaries are very close to the surface of the skin in all of these places, so changes in the blood are quickly reflected at these sites. They are also more accurate indicators than other sites in adults with dark complexions. In infants and children, the best places to look are the palms of the hands and the soles of the feet. In patients with dark skin, you can check the lips and nail beds. Ordinarily, the color you see in any of these places is pink. Abnormal colors include pale, cyanotic (blue-gray), flushed (red), and jaundiced (yellow). Pale skin frequently indicates poor circulation of blood. A common cause of this in the field is loss of blood. Cyanotic skin is usually a result of not enough oxygen getting to the red blood cells. Flushed skin may be caused by exposure to heat. Jaundice is a yellowish lint to the skin from liver abnormalities. An uncommon skin coloration is mottling, a blotchy appearance that sometimes occurs in patients, especially children and the elderly, who are in shock. To determine skin temperature, feel the patient’s skin with the back of your hand. A good place to do this is the patient ‘s forehead. Note if the skin feels normal (warm), hot, cool, or cold. If the patient’s skin seems cold, then further assess by placing the back of your hand on the abdomen. At the same lime, notice the patient’s condition—Is the skin dry (normal), moist, or clammy (both cool and moist)? Look for “goose pimples,” which are often associated with chills. Many patient problems are exhibited by changes in skin temperature and condition. Continue to be alert for major temperature differences on various parts of the body. For example, you may note that the patient’s trunk is warm but his left arm feels cold. Such a finding can reveal a problem with circulation.

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SIGNIFICANCE/POSSIBLE CAUSES

SKIN COLOR Pink

Normal in light-skinned patients; normal at inner eyelids, lips, and nail beds of darkskinned patients

Pale

Constricted blood vessels possibly resulting from blood loss, shock, hypotension, emotional distress

Cyanotic (blue-gray)

Lack of oxygen in blood cells and tissues resulting Iron inadequate breathing or heart function

Flushed (red)

Exposure to heat, emotional excitement

Jaundiced (yellow)

Abnormalities of the liver

Mottled (blotchy)

Occasionally in patients with shock

SKIN TEMPERATURE and CONDITION

“

SIGNIFICANCE/POSSIBLE CAUSES

Cool, clammy

Sign of shock, anxiety

Cold, moist

Body is losing heat

Cold, dry

Exposure to cold

Hot dry

High fever, heat exposure

Hot, moist

High fever, heat exposure

“Goose pimples” accompanied by shivering, chattering teeth, blue lips, and pale skin

Chills, communicable disease, exposure to cold, pain, or fear

Sa mga sanggol at bata na edad anim na taon pababa, dapat suriin ang capillary refill. Pisilin ang kuko sa kamay o paa o kaya ay diinan ang dulo ng kamay at paa at tingnan kung gaano katagal babalik ang rosas na kulay nito. Sa isang normal na bata, dalawang segundo lang ay bumabalik na ang rosas na kulay. Kung mas matagal bago ito bumalik, ang ibig sabihin ay hindi nakakadaloy nang maayos ang dugo ng bata.

or(fixed) nonreactive may indicate variety of conditions conditions in i constrict should be equal. Nonreactive pupils do notindicate constrict response or nonreactive may aa in variety of head injury, or eye injury. Any deviations from norma to a bright light. head injury, or eye injury. Any deviations from normal documented. documented. To check the patient's pupils, first note their size before you shine any light into them. Next, cover one eye as you shine aPUPIL penlightAPPEARANCE into the other eye. The pupil SIGNIFICA PUPIL APPEARANCE SIGNIFICAN should constrict when the light is shining into it and enlarge when you remove C the light. Repeat this process with the other eye. When performing this test, you CA SIGNIFICANCE/POSSIBLE PUPIL APPEARANCE should cover the eye you are not examining because light entering usuCAUSES one eye Dilated {larger than normal) Fright, bloodloss, loss,dd Dilated {larger than normal) Fright, blood ally The affects the size of the pupils in both eyes. When you are examining a patient pupil is the black center of the eye. drops Dilated {larger than Fright, blood loss, drugs, in sunlight orit very bright initially cover both eyes. Afterdrops a few Onedirect of the things that cause to change size conditions, normal) prescription eye drops is the amount of light entering the eye. When seconds, uncover one eye and evaluate it. Cover(smaller it againthan andnormal) repeal with the (narcotics), p Constricted Drugs “ environment the is dim, the pupil will dilate Constricted (smaller than normal) Drugs (narcotics), p “ Constricted (smaller Drugs (narcotics), other eye. (get larger) to allow more light into the eye. than normal) prescription eye drops When there is a lot of light, it will constrict Unequal Stroke,head headinjury, injury (get smaller). Therefore, you will check a Unequal Stroke, Unequal size, unequalStroke, heador injury, eye injury, Pupils that are dilated, constricted to pinpoint in size reactivity, prescription eyedro dr patient’s pupils by shining a light into them. artificial eye, prescription eye prescription eye or nonreactive indicate drug influence, When you check pupils,may you should look for a variety of conditions including drops three things: Size, equality, and reactivity Lack of reactivity Drugs, lackof ofoxyge oxyg head injury, or eye injury. Any deviations from normal should be reported and lack Lack of reactivity Drugs, (reacting to light by changing size). Under Lack of reactivity Drugs, lack of oxygen to brain documented. ordinary conditions, pupils are neither large

PUPILS

nor small, but midpoint. Dilated pupils are extremely large. In fact, it is usually difficult to tell what color eyes the patient has if his pupils are dilated. Both pupils are normally the same size, and when a light shines into them, they react by constricting. The rate at which they constrict should be equal. Nonreactive{larger (fixed) pupils do not constrict in Dilated than normal) response to a bright light.

PUPIL APPEARANCE

To check the patient’s pupils, first note

Constricted (smaller than their size before you shine any light intonormal) them. Next, cover one eye as you shine a penlight into the other eye. The pupil should constrict Unequal when the light is shining into it and enlarge when you remove the light. Repeat this process with the other eye. When performing this test, you should cover the eye you are not Lack of because reactivity examining light entering one eye usually affects the size of the pupils in both eyes. When you are examining a patient in direct sunlight or very bright conditions, initially cover both eyes. After a few seconds, uncover one eye and evaluate it. Cover it again and repeat with the other eye. Pupils that are dilated, constricted to pinpoint size, unequal in size or reactivity, or nonreactive may indicate a variety of conditions including drug influence, head injury, or eye injury. Any deviations from normal should be reported and documented.

NORMAL SIGNIFICANCE/POSSIBLE CAUSES Fright, blood loss, drugs, prescription eye drops Drugs (narcotics), prescription eye drops

CONSTRICTED PUPILS

Stroke, head injury, eye injury, artificial eye, prescription eye drops Drugs, lack of oxygen to brain

DILATED PUPILS ² Limmer (Brady) ² ³Limmer Pollack,(Brady) (AAOS)

³ ⁴Pollack, NHTSA(AAOS) ⁴ NHTSA

UNEQUAL PUPILS

LIFELINE

² Limmer (Brady) ³ Pollack, (AAOS)

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BLOOD PRESSURE Each time the ventricle (lower chamber) of the left side of the heart contracts, it forces blood out into the circulation. The force of blood against the walls of the blood vessels is called blood pressure. The pressure created when the heart contracts and forces blood into the arteries is called the systolic blood pressure. When the left ventricle relaxes and refills, the pressure remaining in the arteries is called the diastolic blood pressure These two pressures indicate the amount of pressure against the walls of the arteries and together are known as the blood pressure. When you take a patient’s blood pressure, you report the systolic pressure first, the diastolic second: for example, as “120 over 80.” or “120/80.”

One blood pressure reading in isolation may not be very meaningful. You will need to take several readings over a period of time while care is provided at the scene and during transport. Changes in blood pressure can be very significant. The patient’s blood pressure may be normal in the early stages of some very serious problems, only to change rapidly in a matter of minutes

BLOOD PRESSURE AGE GROUP

SYSTOLIC

Adults

Less than or equal to 120

Less than or equal to 80

Infants and children

Approx. 80 + 2 x age (yrs)

Approx. 2/3 systolic

Adolescent 11 to 14 years

Average 114 (88 to 120)

Average 76

School age 6 to 10 years

Average 105 (80 to 115)

Average 69

Preschooler 3 to 5 years

Average 99 (78 to 104)

Average 65

BLOOD PRESSURE

SIGNIFICANCE/POSSIBLE CAUSES

High blood pressure

Medical condition, exertion, fright, emotional distress, or excitement

Low blood pressure

Athlete or other person with normally low blood pressure; blood loss; late sign of shock

Hindi kadalasan kinukunan ng blood pressure ang mga sanggol o bata na edad tatlong taon pababa. Sa mga pagkakataon na ang pasyenteng sanggol o bata ay nagkaroon ng malubhang sugat o dumanas ng shock, mananatili ang normal na blood pressure nito at babagsak lamang nang bigla kung ito ay malapit nang mamatay.

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UNIT 2 DAY 8 Pulse and respiratory rates vary among CONCEPT individuals, but blood pressureCRITICAL is a little different. A normal blood pressure is a systolic pressure Palpation is not as accurate as of no greater than 120 millimetres mercury auscultation,ofsince only an ap(mmHg) and a diastolic proximate pressure of no greater systolic pressure can be determined. Palpation is used than 80 mmHg. Millimeters of mercury refers to when there is If too the units on the blood pressure gauge. an much adult noise a patient lo allow or thea use has a systolic pressure ofaround 140 mmHg or greater of the stethoscope. Blood pressure diastolic pressure of 90 mmHg or greater, the person monitors are improving in quality has hypertension (high blood pressure). Readings and many emergency departEMS and agencies between these limits (121ments to 139and mmHg 81 to use them.a condition sometimes 89 mmHg diastolic) indicate called pre-hypertension. This means the patient is at risk of developing some of the complications of hypertension like heart disease, stroke, or kidney disease.

FUNDAMENTALS OF EMT PRACTICE Three common techniques arc used to measure 5. Obtain the diastolic Continue to deflate the cuff, listening for blood pressure with apressure. sphygmomanometer: the point at which these distinctive sounds fade. When the sounds turn to dull, muffled thuds, the reading on the gauge is the diastolic pressure.

1. Auscultation, a stethoscope is used lo in these sounds. When Sometimes youwhen will not be able to hear a change listen for characteristic sounds this happens, the point at which the sounds disappear is the diastolic pressure. when the radial pulse or brachial 2. Palpation, 6.pulse Record measurements. the diastolic pressure, let the cuff is palpated (felt) After withobtaining the fingertips deflate rapidly. Record the measurements and the time. For exam3. Blood pressure monitor, when a machine ple."Blood pressure is 140/90 at 1:10 p.m." Blood pressure is reported in controls inflation the cuff detects even numbers. If a of reading falls and between twochanges lines on the gauge, use the inhigher bloodnumber. flow in the artery.

Serious low blood pressure is generally considered to exist when the systolic pressure falls below 90 mmHg. Many individuals under stress (like that caused by having the ambulance come lo their home) will exhibit a temporary rise in blood pressure. More than one reading will be necessary to decide if a high or low reading is only temporary. If the blood pressure drops, your patient may be developing shock (however, other signs are usually more important early indicators of shock). Report any major changes in blood pressure to emergency department personnel without delay. To measure blood pressure with a sphygmomanometer (the “cuff and gauge), first place the stethoscope around your neck. Position yourself at the patient’s side and place the blood pressure cuff on his arm. The cuff should cover two-thirds of the upper arm, elbow to shoulder. Be certain that there are no suspected or obvious injuries to this arm. There should be no clothing under the cuff. If you can expose the arm sufficiently by rolling the sleeve up, do so, but make sure that this roll of clothing does not become a constricting band. Wrap the cuff around the patient’s upper arm so that the lower edge of the cuff is about one inch above the crease of the elbow. The center of the bladder must be placed over the brachial artery, the major artery of the arm The marker on the cuff (if provided) should indicate where you place the cuff in relation to the artery. However, many cuffs do not have markers in the correct location. Tubes entering the bladder are not always in the right location, either. According to the American Heart Association, the only accurate method is to find the bladder center. Apply the cuff so it is secure hut not overly tight. You are now ready to begin your determination of the patient’s blood pressure.

Determining Blood Pressure by Auscultation, Follow these steps: 1. Prepare. The patient should he seated or lying down. If the patient has not been injured, support his arm at the level of his heart.

2. Position the cuff and the stethoscope. Place the cuff

snugly around the upper arm so that the bottom of the cuff is just above the elbow. With your fingertips, palpate the artery at the crease of the elbow. Place the ear pieces ² Limmerbrachial (Brady) ³ Pollack, (AAOS) ⁴ NHTSAof the stethoscope in your ears (the ear pieces should be pointing forward in the direction of your ear canals). Position the diaphragm of the stethoscope directly over the brachial pulse or over the medial anterior elbow (front of the elbow) if LIFELINE

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around a patient lo allow the use of the stethoscope. Blood pressure monitors are improving in quality and many emergency departments and EMS agencies use them. Determining Blood Pressure by Palpation, Follow these steps: 1.

Day 8

CRITICAL CONCEPTS Palpation is not as accurate as auscultation, since only an approximate systolic pressure can be determined. Palpation is used when there is too much noise around a patient to allow the use of the stethoscope. Blood pressure monitors are improving“ in quality and many emergency departments and EMS agencies use them.

UNIT UNIT2 2 DAY DAY8 8

MEASURING VITAL SIGNS

Position the cuff and find the radial pulse. Apply the cuff as described for auscultation. Then find the radial pulse on the arm to which the cuff has been applied. If a radial pulse cannot be palpated, find the brachial pulse. Inflate the cuff. Make certain that the adjustable valve is closed on the bulb and inflate the cuff to a point where you can no longer feel the radial pulse. Note this point on the gauge and continue to inflate the cuff 30 mmHg beyond this point. Obtain and record the systolic pressure. Slowly deflate the cuff, noting the reading at which the radial pulse returns. This reading is the patient's systolic pressure. Record your findings as, for example, "blood pressure 140 by palpation" or " 140/P" and the time of the determination. (You cannot determine a diastolic reading by palpation.)

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

P p a a u

no brachial pulse can be found. Do not place the head of

Kung sobra ang ingay at hindi na marinig ang pulso sa pamamagitan ng stethoscope, maaaring kapain na lamang ang pulso. Palpation ang tawag dito. Pero hindi ito gaanong accurate. Higit na accurate pa rin ang mga blood pressure monitors na ginagamit na ngayon sa mga emergency rooms ng ospital.

If you are not certain of a reading, repeat the procedure. You should use the the stethoscope underneath the cuff, since this give you other arm or wait 1 minute before re-inflating the cuff. Otherwise, you will tend falsean readings. to obtain erroneously high reading. If you are still not sure of the reading, try again or get some help. Never make up vital signs!

3. Inflate the cuff. With the bulb valve (thumb valve) closed, inflate the cuff. As you do so. you soon will

be able to hear pulse sounds. Inflate the cuff, watching the gauge. At a certain point, you will no longer hear ² Limmer (Brady) the brachial pulse. Continue to inflate the cuff until the ³ Pollack, (AAOS) ⁴ NHTSA gauge reads 30 mm higher than the point where the pulse sound disappeared.

4. Obtain the systolic pressure. Slowly release air from

“ “

the cuff by opening the bulb valve, allowing the pressure to fall smoothly at the rate of approximately 5 to 10 mm per second. Listen for the start of clicking or lapping sounds. When you hear the first of these sounds, note the reading on the gauge. This is the systolic pressure.

5. Obtain the diastolic pressure. Continue to deflate the

cuff, listening for the point at which these distinctive sounds fade. When the sounds turn to dull, muffled thuds, the reading on the gauge is the diastolic pressure. Sometimes you will not be able to hear a change in these sounds. When this happens, the point at which the sounds disappear is the diastolic pressure.

6. Record measurements. After obtaining the diastolic

pressure, let the cuff deflate rapidly. Record the measurements and the time. For example: “Blood pressure is 140/90 at 1:10 p.m.” Blood pressure is reported in even numbers. If a reading falls between two lines on the gauge, use the higher number.

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If o t a

FUNDAMENTALS FUNDAMENTALSOF OFEMT EMTPRACTICE PRACTICE Palpation is not as accurate as auscultation, since only an approximate systolic pressure can be determined. Palpation is used when there is too much noise around a patient lo allow the use of the stethoscope. Blood pressure monitors are improving in quality and many emergency departments and EMS agencies use them.

Determining blood pressure by palpation, follow these steps: 1. Position the cuff and find the radial pulse.

Palpation is not as as accurate as as auscultation, since only anan approximate systolic Palpation is not accurate auscultation, since only approximate systolic pressure can bebe determined. is used when there is too much noise Apply thePalpation cuff as described forwhen auscultation. Then pressure can determined. Palpation is used there is too much noise around a patient lo find allow the useuse of thethe stethoscope. pressure around a patient lo allow the of stethoscope. Blood pressure monitors the radial pulse on the arm toBlood which the cuffmonitors has areare improving in in quality and many departments EMS agencies improving quality and many emergency departments and EMS agencies been applied. Ifemergency a radial pulse cannot beand palpated, useuse them. them. find the brachial pulse.

Determining Blood Pressure byby Palpation, Follow these steps: Determining Blood Pressure Palpation, Follow these steps:

2. Inflate the cuff. Make certain that the adjustable

May mga pagkakataon na bigla na lang mawawala ang tunog ng pulso sa mga pasyente na may mataas na systolic blood pressure. Tapos bumabalik ang tunog habang inaalis mo ang hangin sa blood pressure monitor. Dahil dito, nagkakamali ang pagsukat ng blood pressure. Kung makita mo na mataas ang diastolic pressure, maghintay ng isa o dalawang minuto at sukatin itong muli. Pakinggan mabuti ang tunog. Ang diastolic pressure ay ang huling malakas na tunog na madidinig mo.

1. 1. Position thethe cuff and find the radial pulse. Apply thethe cuff as as described Position cuff find the radial pulse. Apply cuff valve isand closed on the bulb and inflate the cuff todescribed a forfor auscultation. find the radial pulse on thethe arm to to which thethe cuff auscultation. Then find the radial pulse on the arm which cuff pointThen where you can no longer feel radial pulse. hashas been applied. If a radial pulse cannot be palpated, find the brachial been applied. If a radial pulse cannot be palpated, find the brachial Note this point on the gauge and continue to inflate pulse. pulse. the cuff 30 mmHg beyond this point. 2. 2. Inflate thethe cuff. Make certain that thethe adjustable valve is closed onon thethe Inflate cuff. Make certain that adjustable valve is closed When the heartbeat is irregular, the interval bulb and inflate thethe cuff to to a point where you can nono longer feel thethe bulb and inflate cuff a point where you can longer feel radial pulse. Note thisthis point onon thethe gauge and continue toSlowly inflate thethe between heartbeats can vary a great deal. You may obtain radial pulse. Note point gauge and continue to inflate cuff 3030 mmHg beyond thisthis point. cuff mmHg beyond point. the reading at which the an artificially low blood pressure reading if you pass deflate the cuff, noting 3. 3. Obtain and record the systolic pressure. Slowly deflate the cuff, noting Obtain and record the systolic pressure. Slowly deflate the cuff, noting the systolic or diastolic pressure between two widely radial pulse returns. This reading is the patient’s thethe reading at at which thethe radial pulse returns. This reading pa-pa- separated beats, especially if you deflate the cuff quickly. If reading which radial pulse returns. This reading is the systolic pressure. Record your findings as, foris the tient's systolic pressure. Record your findings as,as, forfor example, "blood tient's systolic pressure. Record your findings example, example, “blood 140 by palpation” or “ "blood the patient’s heartbeat is irregular, you should deflate the pressure 140 byby palpation" orpressure " 140/P" and thethe time of of thethe determinapressure 140 palpation" or " 140/P" and time determinacuff a little more slowly and listen even more carefully to 140/P” and the time of thereading determination. You tion. (You cannot determine a diastolic byby palpation.) tion. (You cannot determine a diastolic reading palpation.)

3. Obtain and record the systolic pressure.

cannot determine a diastolic reading by palpation.

obtain an accurate reading.

Determining blood pressure by blood pressure monitor, follow these steps: 1. Position the cuff. Apply the cuff as described for auscultation.

2. Inflate the cuff. Press the button that tells the monitor to begin inflating the cuff.

3. Obtain and record the blood pressure. After

f you areare notnot certain of a reading, repeat thethe procedure. You should useuse thethe If you certain a not reading, repeat procedure. should If youofarebefore certain of a reading, repeat You the procedure. other arm or or wait 1 minute re-inflating thethe cuff. Otherwise, you willwill tend other arm wait 1 minute before re-inflating cuff. Otherwise, you tend You shouldhigh use the otherIf arm orare wait one minute before to to obtain anan erroneously reading. you are stillstill not sure of of the reading, trytry obtain erroneously high reading. If you not sure the reading, re-inflating the make cuff. Otherwise, you will tend to obtain an again or or getget some help. Never upup vital signs! again some help. Never make vital signs!

erroneously high reading. If you are still not sure of the reading, try again or get some help. Never make up vital signs!

the monitor has finished deflating the cuff, it will indicate the patient’s blood pressure on a screen. If it cannot get a blood pressure, it will tell you, Some monitors will give not only the systolic and diastolic pressures but also the mean arterial pressure (MAP). As this is not typically used in prehospital care, do not let it distract you from the numbers you are seeking.

² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

LIFELINE

PREHOSPITAL EMERGENCY CARE

191

Day 8

MEASURING VITAL SIGNS

UNIT 2 DAY 8

UNIT UNIT FUNDAMEN

Unless medical direction advises otherwise, the first blood pressure you get should be with the auscultation method. Although the quality of blood Sukatin ang blood pressure monitors has been improving, these machines still make errors pressure ng lahat ng pasyente and occasionally fail. This may be more likely to happen in the prehospital mo na higit tatlong taong environment. The blood pressure obtained by auscultation is the standard that normal temperature is not n gulang pataas.AMahirap other blood pressures will be compared against. If a reading from the blood perature kunan ng blood pressure depends on the time o pressure monitor is very different from the auscultated blood pressure, check measured, ang mga sanggol o bata na and simple genetics— the blood pressure yourself by auscultation or palpation. Many blood pressure temperature than other people mas mababa sa tatlo ang TAKING AXILLARY TEMPERAmonitors have timers you can set to take the blood pressure every 5 minutes, TAKING TAKING AXILLARY AXILLARYTEMPERATEMPERA edad. Para sa the mga ganitong day and night and usually r TURE every 15 minutes, or at some other interval determined by the operator. This TURE TURE pasyente, obserbahan na lower temperatur tend tomohave Prepare can provide a useful reminder to the EMT when it is time1.to check the restthe of thermometer 1.1.malaman Prepare Preparethe thethermometer thermomete lamang sila para often about one degree highe (digital) check if it is in the vital signs again. It is important that the EMT follow the manufacturer’s (digital) (digital) check check if ifit itis isini ang kanilang lagay -directions and local medical direction in using an automated blood perature is frequently about a d goodpressure working condition. tingnan ang kanilang good goodworking workingcondition. condition. monitor or any other device used in patient assessment. 2. Clean the tip of the thersomewhere near 98.6"F or hitsura kung ture 2.2. Clean Cleanthe thetiptipofofthe thetherthe temperatures that are not "nor mometer in a circular momukha mometer mometerinina acircular circularmomo Vital signs are usually taken more than once. How frequently they should healthy, normal person will hav bang may tion with cotton balls and be repeated depends on the patient’s condition and your interventions, Stable tion tion with with cotton cotton balls balls and an sakit o wala, at 100°F. alcohol patients need repeat vital signs at least every 15 minutes. Unstable patients alcohol alcohol pakinggan 3.vitalChoose which axilla you ang need repeat vital signs at least every 5 minutes. Also repeat signs after 3. 3. Choose whichaxilla axillayou yo paghinga, Malaking Choosewhich will because take the every medical intervention. Record every reading of the vital signs, if temperature, will will take take the the temperature, temperature tulong din kung you don’t write them down, you probably won’t remember them. wipe off the axilla conscious if it is o may malay wipe wipeoff offthe theaxilla axillaif ifit itis sweaty, it not wiped ang off, pasyente. sweaty, sweaty,it itnot notwiped wipedoff, of

DAY DAY

AXILLA

TEMPERATURE

The human body continuously generates and loses heat but manages to maintain a temperature within a narrow range that allows chemical reactions and other activities to take place inside the body. For most patients an EMT encounters, the temperature will not be important, although for some it may be. This includes cases where the 5. patient may be hypothermic or hyperthermic (with a below normal or above normal temperature, often from a change in the environment), febrile (feverish), or suffering from a generalized infection (septic). One very important use for temperature is in screening 6. for influenza. Since many EMS systems now record patient data electronically, this has allowed health departments to 7. evaluate EMS data during flu season to see if there has been an outbreak of the disease in a particular area. By looking for patients with signs and symptoms consistent with influenza, including fever, public health specialists may be able to detect outbreaks earlier than ever before. You learned earlier in this chapter about skin color, temperature, and condition. In this section, we are dealing not with the surface temperature of the skin, but with the body’s core temperature, or the closest we can get to measuring it. The core temperature reflects the level of heat inside the trunk, where the heart, lungs, and digestive organs function. Since it is usually not practical to place a thermometer inside someone’s heart or stomach, we

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it’ll affect the result afterit’ll it’llaffect affectthe theresult resultafterafte wards wards wards Place the tip of the ther4.4. Place Placethe thetiptipofofthe thetherthe mometer on the axilla and mometer mometeron onthe theaxilla axillaand an have thethe patient it foravailable. Traditionally, this is measure closest clip substitute have have the the patient patient clip clip it it for fo either some an oral or rectal but it is also possible to quite time ortemperature, until quite quite some some time time or or until unt get an axillary temperature the thermometer make initthe armpit (axilla). the thethermometer thermometermake makeit signal (you will hear a signal signal (you (you will will hear hear a Although glass thermometers are usually accurate, beeping sound) the conditions EMTs encounter in the field make themsound) beeping beeping sound) Once you heard beepundesirable. Pullingthe a piece of glass into theOnce patient’s mouth 5.5. Onceyou you heard heardthe thebeepbeep ing gentlyover raise the roads in the back of a moving andsound, then travelling bumpy ing ingsound, sound,gently gentlyraise raisethe th arm of therisks patient ambulance injuringwhile the patient from broken glass. A arm armofofthe thepatient patientwhile whil quicker waythe to getthermomean oral temperature is to use an electronic removing removing removing the thethermomethermome thermometer, which usually provides a reading in just a few ter. ter. ter. seconds.the This isthermometer also safer and mote hygienic, since these Check 6. Check Check the the thermometer thermomete machines usually employ metal probes6.with disposable plastic reading and record it covers. To get a temperature with an electronic thermometer, reading reading and andrecord recordit it Turn thermometer put a off new the plastic cover over the probe,7. insert itTurn under the 7. Turn off off the thethermometer thermomete and clean it with cotton patient’s tongue, and follow the manufacturer’s instructions. and andclean cleanit itwith withcotton cotto balls same When and an oralalcohol temperature is not practical, you can sometimes balls balls and and alcohol alcohol same sam get an axillary temperature. manner before using it. Rectal temperatures are not manner manner before before using using it. it. usually practical or necessary in the field. Tympanic thermometers that measure the temperature in the ear are commercially available and frequently used but are not accurate enough for EMS use. Numerous evaluations of these devices have consistently found that the margin of error is quite wide. Many patients are misclassified as having abnormally high or low temperatures by tympanic devices. Forehead thermometers, strips placed on the forehead, are also not accurate enough for EMTs to use.

temperature than other people. Temperature TAKING AXILLARY TEMPERAthe the day dayand andnight nightand andusually usuallyrises riseswith with increased physical physical activity.Older Older people people TURE TURE theincreased day and night andactivity. usually rises with increa TURE tend to to have have lower lower temperatures temperatures than than younger younger people. people. A A rectal rectal temperature temperature is is 1.1. Prepare Preparethe thethermometer thermometer tend tend to have lower temperatures than young 1. Prepare the thermometer oftenabout about one one degree degree higher higher than than an an oral oral temperature, temperature, and and an an axillary axillary temtem(digital) (digital)check checkif ifit itis isinin often often about one degree higher than an oral (digital) check if it is in perature perature is isfrequently frequently about abouta adegree degreeperature lower. lower.Most Most people peoplehave have a atypical temperatemperagood goodworking workingcondition. condition. is frequently about atypical degree lower. M good working condition. ture somewhere near 98.6"F oror37*C 37*Cbut butmany manyhealthy healthy people people walk walk around with with 2.2. Clean Cleanthe thetiptipofofthe thetherther- ture ture somewhere near 98.6"F oraround 37*C but many 2. somewhere Clean the near tip of98.6"F the thertemperatures that that are are not not "normal" "normal" by by these these traditional traditional measures. measures. In In general, general, aa t mometer mometerinina acircular circularmomo- temperatures temperatures that are not "normal" by these mometer in a circular mohealthy, healthy, normal normal person person will will have have a a temperature temperature greater greater than than 96°F 96°F and and less less than than tion tion with with cotton cotton balls balls and and healthy, normal person will have a temperatur tion with cotton balls and TT22 100°F. 100°F. alcohol alcohol 100°F. TEMPERATURE alcohol A normal temperature is not necessarily 98.6°F TAKING AXILLARY YY88 3.3. Choose Choose whichaxilla axillayou you (37°C). A which person’s normal temperature depends on the which axilla you 3. Choose will willtake take the the temperature, temperature, time of day, activity level, age, where the temperature will takeis the temperature, 1. Prepare the thermometer (digital). Check if it is measured, and peoplewipe just have AXILLARY AXILLARY TEMPERATURE TEMPERATURE wipe wipeoff offthe thesimple axilla axillagenetics—some if ifit itis is AXILLARY TEMPE condition. off athe axilla ifin itgood is working higher or lower normal temperature than other people. necessarilysweaty, 98.6°F (37'C). A person's normal temsweaty, it it not not wiped wiped off, off, 2. Clean the tip of the thermometer in a circular sweaty, it not wiped off, AAnormal normal temperature temperature is isnot not necessarily necessarily98.6°F 98.6°F(37'C). (37'C).AAperson's person'snormal normaltemtemTemperature rises and falls attemperature different times is of the of day. activity level, age. where the motion with cotton balls it’ll it’llaffect affect the the result result afterafterit’ll affect the result afterperature perature depends depends on on the the time time of of day. day. activity activity level, level, age. age. where where the the temperature temperature is is and alcohol. day and usually rises with increased physical —some people justnight haveand a higher or lower normal 3. Choose which axilla you will take the wards wards wards measured, measured, and and simple simple genetics—some genetics—some people people just justhave havea ahigher higher ororlower lowernormal normal activity. Older people tend to have lower temperatures temperature on. Wipe off the axilla if it is e. Temperature rises and falls al therdifferent times 4.temperature 4. Place Place the the tiptip ofother ofthe the ther4. isof Place theand tip falls offalls the thertemperature than than other people. Temperature Temperature rises rises and alaldifferent different times times of the sweat will affect the Athan younger people. Apeople. rectal temperature often about sweaty. It not wipedof off, rises with increased physical activity. Older people mometer mometer on onthe the axilla axilla and one degree higher than anand oral temperature, and an physical mometer on the activity. axilla and the theday day and andnight night and and usually usually rises riseswith withincreased increased physical activity. Older Older people people result afterwards. res than younger people. Aclip rectal temperature is lower. have have the the patient patient clip it itfor for about axillary temperature is frequently ayounger degree have the patient clip it temperature for tend to tohave have lower lower temperatures temperatures than than younger people. people. AArectal rectal temperature is is rer tend 4. Place the tip of the thermometer on the axilla er than an quite oral temperature, and an axillarysomewhere tempeople have a typical temperature quite some some time time or or until until and have the patient clip it for quite some time quite some time and or until oftenMost about about one one degree degree higher higher than thanananoral oraltemperature, temperature, and anan axillary axillary temtemnin often degree lower. Most people a typical temperanear 98.6°F or 37°Chave but many healthy peoplethe walkthermometer make the the thermometer thermometer make make it until thermometer it thetemperaperature perature is is frequently frequently about about a ait degree degree lower. lower.Most Most people peoplehave haveaoratypical typical tempera- makes its signal (you around with temperatures that are not “normal” by 37*C but signal many healthy people walk around with will hear a beeping sound). signal (you (you will will hear hear a a signal (you will hear a ture turesomewhere somewhere near near 98.6"F 98.6"FIn oror 37*C 37*Cbut many many healthy healthypeople peoplewalk walkaround aroundwith with erthese traditional measures. general, abut healthy, normal rmal" by these traditional measures. In general, a 5. Once you hear the beeping sound, gently raise beeping beeping sound) sound) beeping sound) temperatures that that not not"normal" "normal" byby these these traditional traditional measures. measures. InIn general, general, a while a removing the -o- temperatures person will haveare aare temperature greater than 96°F and the arm of the patient ve a temperature greater than 96°F and less than 5.healthy, 5. Once Once you you heard heard the the beepbeep5. Once you heard the96°F beepnormal normal person person will will have havea atemperature temperature greater greater than than 96°F and and less less than than d nd healthy, less than 100°F. thermometer. ing ingsound, sound,gently gentlyraise raisethe the ing sound, gently raise thethe thermometer reading and record it. 100°F. 100°F. 6. Check arm armofofthe thepatient patientwhile while arm of the patient7. Turn while u ou off the thermometer and clean it with removing removingthe thethermomethermomeremoving the thermomecotton balls and alcohol the same manner as ,e, ARY TEMPERATURE ter. ter. before using it. ter. AXILLARY AXILLARYTEMPERATURE TEMPERATURE s is 6. 6. Check Check the the thermometer thermometer 6. Check the thermometer AXILLARY TEMPERATURE ,ff, reading readingand andrecord recordit it reading and record it er7.7. Turn Turnoff offthe thethermometer thermometer 7. Turn off the thermometer and andclean cleanit itwith withcotton cotton and clean it with cotton erballs balls and and alcohol alcohol same same balls and alcohol same d nd manner mannerbefore beforeusing usingit.it. manner before using it. ror ltil t it aa

NTALS OF EMT PRACTICEOF FUNDAMENTALS FUNDAMENTALS OFEMT EMTPRACTICE PRACTICE

-pehe ele -e-

rer

rer n on me e

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

LIFELINE ² Limmer (Brady)

³ Pollack, (AAOS) ⁴ NHTSA

PREHOSPITAL EMERGENCY CARE

193

Day 8

MEASURING VITAL SIGNS

OXYGEN SATURATION EMTs and other health care providers commonly measure the level of oxygen circulating through a patient’s blood vessels. A measurement of oxygen saturation is not a vital sign, but many EMS providers incorporate it into their gathering of vital signs. The device that measures oxygen saturation of the blood, called a pulse oximeter, sends different colors of light into the tissue at the end of a finger or on an earlobe and measures the amount of light that returns. The machine then determines the proportion of oxygen in the blood and displays the oxygen saturation percentage, also called the SpO₂. A different kind of oximeter uses different wavelengths of light that allow it to measure carbon monoxide (CO) as well as oxygen. For this reason, it is sometimes called a COoximeter. Future versions of this device will very likely be more accurate, less expensive, and easier to use than early models. Interpreting CO-oximeter readings in a particular clinical situation can be challenging, so if you use a COoximeter, be sure to follow your local protocols regarding its application and interpretation.

When to Use a Pulse Oximeter If your service has a pulse oximeter, you should have a protocol describing when to use it. Generally, this will include all patients complaining of respiratory problems. When used properly, the device can help you to assess the effectiveness of artificial respirations, oxygen therapy and bronchodilator (inhaler) therapy.

Interpreting Pulse Oximeter Readings The oxygen saturation, or SpO₂. is typically 96 to 100 percent in a normal healthy person. A value less than 96 percent may sound good, but that is not really the case. A reading of 91 to 95 percent indicates mild hypoxia, 86 to 90 percent indicates significant or moderate hypoxia, and 85 percent or less indicates severe hypoxia. The lower the oxygen saturation reading you get, the more aggressive your management should be. Any indication of hypoxia is reason to administer high-concentration oxygen by non-rebreather mask. For very low readings, you will need to look at the patient’s clinical condition and decide whether to ventilate the patient with high-concentration oxygen. You should try to get the SpO₂ up to at least 96 percent. The reverse situation is not true: that is, a reading above 96 percent does NOT mean you should withhold oxygen from a patient with signs and symptoms that indicate the need for oxygen. 194

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NOTE Never deprive a patient in respiratory distress of supplemental oxygen while attempting to obtain an accurate pulse oximetry reading. For these patients, providing supplemental oxygen, or even assisting ventilations, is a far more important intervention than documenting their “room air” saturation of oxygen.

CAUTION: The following cautions apply to interpreting pulse oximetry readings. • The oximeter is inaccurate with patients in shock and hypothermic patients (those whose body temperatures have been lowered by exposure to cold) because not enough blood is flowing through the capillaries for the device to get an accurate reading. • The oximeter will produce falsely high readings in patients with carbon monoxide and certain other uncommon types of poisoning. This is because carbon monoxide binds with hemoglobin in the blood, producing the red color read by the device. Cigarettes produce carbon monoxide, so chronic smokers may have 10 to 15 percent of their hemoglobin bound to carbon monoxide. This means their oxygen saturation readings will be higher than the actual oxygen saturation. • Excessive movement of the patient can cause inaccurate readings; so can nail polish, if the device is attached to a finger. Carry acetone wipes to quickly remove the nail polish from a patient’s fingernail before attaching the oximeter. Anemia, hypovolemia, and certain kinds of poisoning are other potential causes of falsely high oxygen saturation readings. • The accuracy of the pulse oximeter should be checked regularly, following the manufacturer’s recommendations. The batteries used to power the device must be in good condition and the probe needs to be kept clean to gel accurate readings. • Pulse oximetry is most useful in two situations: evaluating the effect of an intervention you have instituted (when you hope the SpO₂ goes up or remains high) and alerting you to a deterioration in the pattern’s oxygen saturation (when the SpO. starts going down). Like any other device, the pulse oximeter can distract you from the patient. Keep pulse oximetry in its proper place in the assessment. Remember, the oximeter is just another tool. Do not rely on it solely for indications of the patient ‘s condition. Treat the patient, not the device.

ration ration will will not not bebe anan accurate accurate reading reading either. either. 3.3. If If you you get get a poor a poor signal signal oror ""trouble" ""trouble" indicator, indicator, trytry repositioning repositioning the the sensensor sor onon the the finger finger oror moving moving it it toto a different a different finger. finger. 4.4. Once Once you you get get anan accurate accurate reading, reading, check check the the oximeter oximeter reading reading every' every' 55 minutes. minutes. AA convenient convenient time time toto dodo this this is is when when you you check check the the patient's patient's vital vital signs. signs.

Determining oxygen saturation , Follow these steps:

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

1. Connect the sensor lead to the monitor and clip it onto a fingertip (toe or distal foot in an infant). 2. Turn the device on. After a few seconds the device UNIT UNIT22 should display the SpO₂ and heart rate. Make sure the heart rate displayed DAY DAYon88the monitor screen is the same as the patient’s pulse rate (which you palpated already). If the heart rate shown on the pulse oximeter does not match the pulse rate that you have

determined, it is likely that the oxygen saturation will not be an accurate reading either. 3. If you get a poor signal or “trouble” indicator, try repositioning the sensor on the finger or moving it to a different finger. 4. Once you get an accurate reading, check the oximeter reading every 5 minutes. A convenient time to do this is when you check the patient’s vital signs.

FUNDAMENTALS FUNDAMENTALSOF OFEMT EMTPRACTICE PRACTICE

OXYGEN OXYGEN SATURATION SATURATION TAKTAKOXYGEN SATURATION TAKING ING ING 1.1. prepare prepare the the necessary necessary 1. Prepare the Oximenecessary equipment equipment (pulse (pulse Oximeequipment (pulse oximeter). ter) ter) ifin it working isworking in working 2.2. Check Check2. ififCheck itit isis in condition, try to your condition, condition, try try itit totoityour your finger first. finger fingerfirst first 3. Choose what finger you’re 3.3. Choose Choose what what finger finger going to use for checking you’re you’re going going toto use use for for the oxygen saturation. checking checkingMake the theoxygen oxygen satusatusure that the finger ration. ration.Make Make surethat that the the is notsure cold and wet. These finger fingerisisnot not cold cold and and wet. wet. characteristics might alter These These the characteristics characteristics result. might mightalter alter the the result result 4. Place the finger inside the 4.4. Place Placethe the finger finger inside inside the pulse oximeter bythe pressing pulse pulseoximeter oximeter by bybottom pressing pressing down the side to down downthe the bottom bottom sideGently toto separate theside top. separate separateplace the thethe top, top, gently gently finger pad on place place the the fingerprovided pad pad on on thefinger space and the the space space provided and thenprovided release it toand let the then thenrelease release ittotolet letthe the the deviceitmeasure oxygen saturation the inside the device device measure measure the oxyoxy-body. The device will also display gen gensaturation saturation inside inside the the thedevice patient’swill pulse rate. body. body.The The device will also also Take note of the value and display displaythe the patient’s patient’s pulse pulse record it. ofof the rate. rate. Take Take note note the value valueand andrecord recordit.it.

LIFELINE

BLOOD BLOODGLUCOSE GLUCOSEMETERS METERS

PREHOSPITAL EMERGENCY CARE

195

One Oneofofthe themany manyadvances advancesininmanaging managingdiabetes diabetesininthe thelast lastfew fewyears yearshas hasbeen been the thedevelopment developmentofofportable, portable,reliable reliableblood bloodglucose glucosemeters. meters.The Theportability, portability,low low

Day 8

MEASURING VITAL SIGNS

BLOOD GLUCOSE METERS One of the many advances in managing diabetes in the last few years has been the development of portable, reliable blood glucose meters. The portability, low cost, and accuracy of blood glucose meters has made it practical to carry them on the ambulance. They are easy to use, and since they are routinely used by patients, many EMS systems allow EMTs to use blood glucose meters that are carried on the ambulance.

significantly fewer diabetes-related complications (heart disease, blindness, and kidney failure, to name a few). So a person with diabetes has a strong motivation to keep his blood glucose level within the normal range.

UNIT DAY

A blood glucose meter is used by placing a drop of the patient’s blood on a test strip, The blood is traditionally obtained from pricking a finger, although some glucose meters allow patients to obtain the blood from other areas, like the forearm. The glucose meter evaluates the People with diabetes now routinely test the level of change in chemical composition of the material on the glucose in their blood at least once a day, and sometimes 1. strip and displays a number that correlates to the glucose as often as five or six times a day. By determining the 1. Prepare Prepare the the devic devic including concentration in the person’s blood. This number usually amount of glucose in their blood, they can determine including a a test test stri stri and shows the amount of glucose in milligrams per deciliter very precisely how much insulin they should take and and lancet. lancet. 2. of blood (expressed as mg/dL), also called milligrams how much and how often they should eat. Keeping blood 2. Use Use an an alcohol alcohol pre pre to cleanse the patien percent. glucose levels as close to normal as possible leads to 's finger. 3. After allowing th alcohol to dry. use th lancet to perform finger stick on th patient. Wipe awa the first drop of bloo When using the glucose meter Using a Blood Glucose Meter that appears. Squeez follow these steps: If the patient has a glucose the patient's finger meter, the patient or a family to gel EMTs mustnecessary have member can use it to determine second drop of blood 1. Prepare the device including a test permission from the patient’s blood glucose level. Holding the patient strip and lancet. medical direction or Generally. EMTs should not use a hand 2. Use an alcohol prep to cleanse the by local protocol to lower than th patient’s glucose meter. There are heart patient ‘s finger. perform blood glucose and warmin many different types of these devices the hand may in 3. After allowing the alcohol to monitoring using on the market, each with its own crease blood flow. dry, use the lancet to perform a blood glucose meter. instructions for use, which may be 4. Apply the blood l finger stick on the patient. Wipe very different from device to device. the test strip. This i away the first drop of blood that Additionally, there is no way for often done by hold appears. Squeeze the patient’s the EMT to know whether the test ing the strip up to th finger if necessary to get a second strips have been stored properly or finger and then draw drop of blood. Holding the when the device was last calibrated. ing the blood into th patient’s hand lower than the These facts are very important if the strip. heart and warming the hand may reading is to be accurate. 5. The blood glucos increase blood flow. meter analyzes th 4. Apply the blood to the test strip. If you have blood glucose sample and provide This is often done by holding the monitors on the ambulance, they a reading—usually i strip up to the finger and then must he calibrated and stored less than a minute. drawing the blood into the strip. according to the manufacturer’s 5. The blood glucose meter analyzes recommendations. Take Standard the sample and provides a Precautions. reading— usually in less than a minute.

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T2 Y8

4. 5.

on the patient. Wipe away the first drop of blood that appears. Squeeze the patient's finger if necessary to gel a second drop of blood. Holding the patient's hand lower than the heart and warming the hand may increase blood flow. Apply the blood lo the test strip. This is often done by holding the strip up to the finger and then drawing the blood into the strip. The blood glucose meter analyzes the sample and provides a reading— usually in less than a minute.

FUNDAMENTALS OF EMT PRACTICE

ce ce ip ip

ep ep nt

he he a he ay od ze if a d. t's he ng n-

lo is dhe whe

se he es in

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

Dapat munang alamin ng isang EMT kung pinapayagan ng local protocol ang pagsukat ng blood glucose gamit ang blood glucose meter. Ang normal na blood glucose level ay 60 hanggang 80 milligrams per deciliter at hindi lalampas ng 120 hanggang 140.

A normal blood glucose level is usually at least 60 to 80 mg/dL (milligrams per deciliter) and no more than 120 or 140 (depending on the manufacturer’s instructions and local protocols). Although many people use blood glucose meters appropriately and accurately, it is quite common to get an inaccurate reading, especially when the device is not used properly. It is critical for any health care provider who is using a blood glucose meter to test a patient’s blood to have the proper training in use of the device and be thoroughly familiar with its care and maintenance. Calibration and testing on a regularly scheduled basis arc essential if the device is to give accurate results. Remember that the blood glucose monitor is just one tool in your patient assessment. Blood glucose monitoring, or any other examinations, should never be done before performing a thorough primary assessment. Some areas recommend that the blood glucose measurements be done while en route to the hospital.

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CRITICAL CONCEPTS • You can gain a great deal of information about a patient’s condition by taking a complete set of baseline vital signs, including pulse, respirations, skin, pupils, and blood pressure. UNIT •

2 As an EMT, you must DAY become 8

MEASURING VITAL SIGNS

FUNDAMENTALS OF EMT PRACTICE

familiar with the normal ranges for pulse, respirations, and blood pressure in adults and children. CRITICAL CONCEPT • Trends in the patient’s ² Limmer (Brady) condition will become ³ Pollack, (AAOS)  You can gainonly a when greatvital deal apparent signsof ⁴ NHTSA information about a patient's are repeated, an important UNIT UNIT 2 2 UNIT UNIT22 condition by taking a complete step in continuing assessment. set of baseline DAY DAY 88vital signs, includDAY DAY88 ing •pulse, respirations, How often you repeatskin, the puvitalblood signs will depend on the pils, and pressure. patient’s condition: at least everymust 15 minutes for stable  The EMT become familiar patients and at least every 5 for CAL CAL CONCEPT CONCEPT CRITICAL CRITICAL CONCEPT CONCEPT with the normal ranges minutes for unstable patients. pulse, respirations, and blood pressure in adults and children gain gain aa great great deal deal of of You Youcan cangain gaina agreat greatdeal dealofof on n about about aa patient's patient's information information about about a a patient's patient's  Trends in the patient's condition by by taking taking aa complete complete condition bybytaking takinga acomplete complete Upangcondition maging will become apparent only eline eline vital vital signs, signs, includincludset set of of baseline baseline vital vital signs, signs, includincludmahusay na EMT, when skin, vital pusigns are repeated, respirations, respirations, skin, puing ing pulse, pulse, respirations, respirations, skin, skin, pupukailangan kabisado an important step inand continuing lood ood pressure. pressure. pils, pils, and blood bloodpressure. pressure. mo ang mga normal na assessment. sukat ng pulso, paghinga, pressure, at must must become becomeblood familiar familiar The Theglucose EMT EMTmust mustbecome becomefamiliar familiar  How often you repeat the vital iba pang signs. At normal normal normal ranges ranges for forvital with with the the normal ranges ranges for for signs willblood depend onrespirations, the pakailangan matiyaga mong spirations, pirations, and and blood pulse, pulse, respirations, and and blood blood sinusukat ang itoininevery condition: atmga least nn adults adultstient's and and children children pressure pressure adults adultsand andchildren children dependefor sa kondisyon ng 15 minutes stable patients and atiyong leastpasyente. every 5 minutes for the the patient's patient's condition condition Trends Trendsininthe thepatient's patient'scondition condition unstable patients. ome ome apparent apparent only only will will become become apparent apparent only only all signs signs are are repeated, repeated, when whenvital vitalsigns signsare arerepeated, repeated, ant ant step step in in continuing continuing an animportant importantstep stepinincontinuing continuing nt. t. assessment. assessment.

FUNDAMENTALS FUNDAMENTALSFUNDAMENTALS FUNDAMENTALS OF OF EMT EMT PRACTICE PRACTICE OF OFEMT EMTPRACTIC PRACTIC

nn you you repeat repeat the the vital vital How Howoften oftenyou yourepeat repeatthe thevital vital depend depend on on the the papa- signs signs will will depend depend on on the the papaA normal blood glucose level is usually at least 60 to 80 mg/dL (milligrams per ndition: ndition: at at least least every every tient's tient'scondition: condition:atatleast leastevery every deciliter) and no more than 120 or 140 (depending on the manufacturer's ines es for for stable stable patients patients 15 15minutes minutesfor forstable stablepatients patients structions and local protocols). ast st every every 55 minutes minutes for for and andatatleast leastevery every55minutes minutes for for One of the most important factors that determine the normal range of vital signs patients. atients. unstable unstablepatients. patients. is age. Infants and children have faster pulse meters and respiratory rates and and loweraccurately, blood Although many people use blood glucose appropriately pressures than to adults. it is quite common get an inaccurate reading, especially when the device is not used properly. It is critical for any health care provider who is using a blood glucose meter to test a patient's blood to have the proper training in use of the device and be thoroughly familiar with its care and maintenance. Calibration 198 LIFELINE PREHOSPITAL EMERGENCY CARE and testing on a regularly scheduled basis arc essential if the device is to give accurate results. AA normal normal blood blood glucose glucose level level isis usually usually AAnormal normal at at least least blood blood 60 60 glucose glucose to to 80 80 mg/dL mg/dL level levelisis (milligrams (milligrams usually usuallyatatleast per per least60 60toto80 80mg/dL mg/dL(milligrams (milligram deciliter) deciliter) and and no no Remember more more than than that 120 120deciliter) or or deciliter) 140 140 (depending (depending and and no no more more on on than the the than manufacturer's manufacturer's 120 120 or or 140 140 (depending (depending ininon on the the manufacturer's manufacturer the blood glucose monitor is just one tool in your patient assessstructions structions and and local local protocols). protocols). structions structions and andlocal local protocols). protocols). ment. Blood glucose monitoring, or any other examinations, should never he

PEDIATRIC NOTE

Lifeline in Action

RESPONDING TO AN UNCONSCIOUS PATIENT By Jetty Mendoza with Transport Officer Arlan Nawang and Treatment Officer Harold Sunga

One sunny day 2014, our Lifeline team was stationed inside a mall. We were on stand-by, all sitting on our respective chairs, waiting for any type of emergency that may happen. At 10:55 am, we heard our call sign, “Migs Alpha – Central,” on the radio. The dispatcher notified us that there was an emergency in one of the offices at a building nearby. The dispatcher relayed to us the details of the case: A female patient lost her consciousness. We immediately responded on board our ambulance where we prepared the necessary things to accommodate an unconscious patient. We readied our trauma bag, vital signs kit, pulse oximeter, blood glucose meter and a portable oxygen tank. It took us about a minute to get to the lobby area of the building where the patient was. Upon arrival, we were assisted by security personnel in the lobby and guided us to the service elevator where our stretcher could fit. When we got to the fourth floor, we pushed our stretcher to the conference room where the patient was located. We lifted the patient while being assisted by the building nurse on duty. I assessed the patient’s responsiveness, pulse and breathing. She was unable to talk. However, her eyes were open with a blank stare. She was not able to follow a command to move a part of her body. SHE FELL TO THE While our treatment officer was taking the patient’s vital signs, I asked the building nurse what happened. An officemate of the patient reported the patient suddenly lost her consciousness while ¹ American Heart Association. “BLS for Healthcare Providers”, Student Manual (2010):that 6-17. FLOOR AND HAD A sitting and doing some paperwork. She fell to the floor and had a seizure, which was described as jerky movements. The seizure lasted SEIZURE, WHICH ual (2010): 6-17. about two minutes, according to the officemate. WAS DESCRIBED AS After taking the history, we measured the blood glucose of the patient. All vital signs were JERKY MOVEMENTS. recorded. There was no loss of bowel and bladder control. I gave oxygen to the patient via nasal cannula. Safety of the patient was given utmost importance during care. We log-rolled the patient with the head THE SEIZURE and neck assisted to be able to fit a breakaway under her. All seatbelts of the breakaway were fastened LASTED ABOUT TWO and locked. Drapes were applied to the patient’s lower body to prevent exposure of underwear. We carried the breakaway onto the gurney carefully. We headed towards the elevator while being MINUTES assisted by the office guard. The guards on the ground floor cleared the lobby for us so we could easily get to our ambulance. The patient was loaded to the ambulance accompanied by two co-workers and the building nurse. On the way to the hospital, we contacted our central office by radio to inform them about the assessment made and to ask which hospital to endorse the patient. We were told to go to San Juan De Dios Hospital and given the name of a contact person in the emergency room. On the way, we reassessed the patient’s responsiveness, pulse, airway, breathing and vital signs. The patient was already conscious and able to follow simple commands such as slightly moving her fingertips and toes. To our surprise, the patient was shedding a tear yet unable to talk. Her airway was still maintained through oxygen via nasal cannula while en route to the hospital. Arriving at the emergency room, we carefully unloaded the patient using the Stryker Gurney. We were met by the triage nurse who guided us to the acute care area of the ER. We transferred the patient from the gurney to the hospital bed using the breakaway. The breakaway was safely removed and the oxygen was transferred to the hospitals wall-mount. Before the ER doctor came, we rapidly assessed the status of the patient. The patient was now able to talk, blink her eyes and move all parts of her body, although she was still generally weak. The doctor came and interviewed her. The patient couldn’t recall what happened to her. All she remembered was sitting on a chair doing paperwork under severe stress. Apparently, the patient had epilepsy and was taking phenobarbital for maintenance. All documents were endorsed and properly signed by the bedside ER nurse and the co-worker of the patient.

LIFELINE PREHOSPITAL EMERGENCY CARE

YOU have come to the penultimate point in the Lifeline Emergency Medical Technicians Basic (EMT-B) course where you will now be facing the patient. This is one of the most important parts of your training, and we advise you to really take this chapter seriously. The amount of time and effort you dedicate to learning the ropes of patient assessment would surely produce a lot of benefits for you in your career as an EMT. However, we also know that patient assessment is mastered not by reading or by listening to lectures but by getting the opportunity to perform multiple assessments on real patients in the field. Here, experience will be your best teacher. But for now, let the experience of experts and your teachers guide you. In this chapter, you will be provided with a set of guidelines for assessing patients who are ill or injured. Since assessment serves as the foundation of providing care, it is best to always to sharpen up your skills in this arena. Too many times, veterans in the field would simply make the new EMTs do the assessment. Donâ&#x20AC;&#x2122;t fall into that trap. You have to assess patients yourself, or your skills in assessment may become rusty. In this chapter, you will know the basics of patient assessment. You will also learn the importance of being a good communicator -- one who reassures the patient and inspired confidence among your team members. Remember, your assessment of the patient will be the basis of care other healthcare providers would give your patient. So make sure you really do a thorough and accurate work.

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Initial Assessment Approach to Primary Assessment Critical Decision Making Assessment of Medical Patient Assessment of Trauma Patient

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LEARNING OBJECTIVES • Describe methods or ways of assessing the patient’s breathing. • State what care should be provided to the adult, child and infant patient with or without adequate breathing. • Describe the methods used to obtain a pulse. • Describe normal and abnormal findings when assessing skin color, temperature, condition and capillary refill in infant and child patient.

INTRODUCTION As a matter of practice, it is always prudent to take your time in doing a thorough assessment of the patient, transporting only after you have completed this on the scene. However, there are instances when the patient has a life threatening problem—such as a blocked airway, a stoppage of breathing or heartbeat, or severe bleeding—that you must provide emergency care immediately. This is the major principle guiding the primary assessment Here you will get critical information about the seriousness of your patient’s condition, which will be the foundation for important decisions as you continue the care of your patient.

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INITIAL ASSESSMENT THE PRIMARY ASSESSMENT Primary assessment is the portion of the patient assessment during which you will focus exclusively on life threats—specifically those that interfere with airway, breathing, and circulation. This chapter deals with this very vital part of the assessment process. Primary assessment is also referred to as the primary survey or initial assessment. Whatever it is called, primary assessment is always the first clement in the total evaluation of the patient.

Approach to Primary Assessment As an EMT you will see many different patients with varied medical and traumatic conditions. The primary assessment can—and should—vary depending on several factors that include the patient’s condition, how many EMTs are on the scene, and other priorities you determine as you assess your patient. Ang primary assessment ay ang pangunahing pagsusuri sa pasyente. Dito inaalam kung ano ang dapat unahing gawin para mailigtas ang pasyente. Kailangan maging mabilis ang initial assessment dahil dito nakasalalay ang buhay at mabilis na paggaling ng pasyente.

Consider the following patient conditions and situations: • You are called to a responsive patient who dropped a concrete block on his foot and is in considerable pain. • You are eating in a restaurant and observe a man with what appears to be a complete airway obstruction. • You arrive at the side of a patient who had “’passed out” and is now moaning. She has vomited.

• You are called to provide assistance to a “man down” and see a person on the ground who does not appear to be moving or breathing. • You are called for an industrial accident and find a man who looks pale, sweaty, and about to pass out. He has blood spurting from his thigh.

It is essential that you record all vital signs as you obtain them, along with the time at which you took them.

PREHOSPITAL EMERGENCY CARE

NOTE: Most of the contents of this chapter was based on the book “Emergency Care” by Daniel Limmer and Michael O’Keefe. Used with permission from Pearson Education, the publisher of the book.

In the responsive patient who dropped a block on his foot, you will perform a primary assessment, but little action will be required. The other patients will require you to perform many vital actions. The man who is choking needs to have his airway cleared as a first priority. The woman who passed out is in immediate need of suction. The “man down” will likely need CPR. For this patient, compressions and defibrillation are your first priorities. The man with spurting blood is essentially bleeding to death. In this case you must immediately take action to stop the bleeding.

Decision Making in the Primary Assessment The mnemonic A-B-C can help you remember the things you have to do in the primary assessment—but not the exact order in which you must perform them. To determine exactly what you will do and in what sequence during the primary assessment, there are certain general considerations you will take into account. • Any vomit in the airway that enters the lungs is very serious—and often fatal. The stomach contents contain solids that may obstruct the airway as well as strong acids that can cause irritation within the airway. Some patients are saved by defibrillation but later die because of aspiration pneumonia or pneumonitis. It is a vital component of the primary assessment to suction the airway us soon us needed and before ventilating. • Exsanguinating (very severe, life-threatening) bleeding must be stopped immediately. Damage to major vessels, especially arteries, can cause death extremely rapidly from bleeding. Life-threatening bleeding must be controlled immediately. • Breathing and circulation are obviously vital for life. You must make sure your patient is breathing and breathing adequately to support life. In cases where there appears to be no breathing or only very occasional, ineffective breaths (agonal breathing), you should check for a pulse and begin CPR if necessary. • If immediate interventions such as bleeding control or CPR are not required, you will shift into an important but less urgent mode in which you will administer oxygen appropriate for the patient’s condition and evaluate for shock. Again, the order in which these interventions are performed depends on the patient’s specific condition and the number and priority of the urgent conditions just listed that you are presented with. Remember: Multiple EMTs can accomplish multiple priorities simultaneously.

Remember that you will not be alone in an ambulance. Professional rescuers (EMTs are included in this category) will often work in a team environment in which multiple tasks may be accomplished immediately and simultaneously. In this case there is no need to wonder whether you should open the airway first or stop the bleeding first, because both may be done at the same time. It is also possible that a friend, family member, or even the patient himself may be able to help control bleeding while you do other important tasks.

Performing the Primary Assessment Keep in mind that the initial steps of the primary assessment will depend on your initial impression of the patient. As already noted, if the patient shows signs of life you will begin to work through the ABCs in an order dictated by your patient’s priorities If the patient appears lifeless—that is. not moving and apparently not breathing— you will take a different course of action and shift toward resuscitation beginning with chest compressions and preparation of the defibrillator if the patient is pulseless.

Primary assessment is actually considered to have six parts: 1. Forming a general impression 2. Assessing the patient’s mental status and manually stabilizing the patient’s head and neck when appropriate 3. Assessing the patient’s airway 4. Assessing the patient’s breathing 5. Assessing the patient’s circulation 6. Determining the patient’s priority

Kung sa primary assessment mo ay nadiskubre mo na posibleng mamatay ang pasyente, gawin mo na agad ang alam mong dapat gawin para maitama ang sitwasyon maisalba ang buhay nito.

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INITIAL ASSESSMENT

Form a General Impression Forming a general impression helps you determine how serious a patient’s condition is and to set priorities for care and transport. It is based on your immediate assessment of the environment and the patient’s chief complaint and appearance. The environment can provide a great deal of information about the patient. It frequently gives clues— if only you would look for them—about your patient’s condition and history. One of the most important things it can sometimes tell you is what happened. Is there an overturned ladder, indicating that the patient may have fallen? Has the patient been exposed to a hot outdoor environment for a long time? Or is there no apparent mechanism of injury, leading you to presume that the patient has a medical problem rather than trauma? Although you cannot rely completely on the patient’s environment to rule out trauma, when combined with the chief complaint (e.g. the patient complaining of symptoms that sound more like a medical problem than an injury), environmental clues become extremely useful.

Manual Stabilization of the Head and Neck You should apply manual stabilization of the head and neck on first contact with any patient you suspect may have an injury to the spine based on mechanism of injury, or history, or signs and symptoms—that is, to virtually any trauma patient. When you apply manual stabilization, your object is to hold the patient’s head still in a neutral, in-line position. That is, the head should be facing forward and not turned to either side nor tilted forward or backward. You must be careful not to pull or twist the patient’s head but rather to hold it perfectly still and to remind the patient not to try to move it. If your patient is in another position (for example, crumpled on his side) or is being moved by other EMS personnel, adapt the technique to the best of your ability to hold the head in a steady position in line with the spine. Some EMS systems have specific guidelines for when to use and when not to use spine immobilization. If this is the case in the system where you work, you should familiarize yourself with the local protocols and follow them. 1. When your patient is sitting up, position yourself just behind the patient and hold the patient’s head by spreading your fingers over the sides of the head and placing your thumbs behind the ears. 2. When your patient is supine, kneel behind the patient and spread your fingers and thumbs around the sides of the patient’s head to hold it steady.

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The “Look Test” At this point, experienced providers often get a “feeling” about the patient’s condition. This feeling comes from environmental observations as well as from the brief but valuable inform obtained by that first look at the patient as the EMT approaches. Some call this the “look test.” You will gain more of this instinctual approach to assessment as you gain experience. This chapter will discuss how and why they play a part in your assessment. For now. we will tell you some of the things experienced EMTs use to identify patients who may be critical, such as: • PATIEnTS WHO APPEAR LIFELESS. Patients who appear to be lifeless—who have no movement or apparent evidence of breathing or have only gasping breathing— will be resuscitated by beginning CPR compressions and preparing your defibrillator as soon as possible ir they arc found to be pulseless. • PATIEnTS WHO HAvE An OBvIOuS ALTERED MEnTAL STATuS. An altered mental status can indicate many underlying conditions, from hypoxia to shock to diabetes to overdose to seizure. During the primary assessment, your concern is not the cause of the altered mental status; it is the impact it will have on your patient and your assessment and care decisions In this case: 1. Your primary assessment will be more aggressive because of a higher potential for life-threatening problems, including vomit us or secretions in the airway and the need for ventilation. 2. Your subsequent assessments will likely be done more quickly to expedite transport. • PATIEnTS WHO APPEAR unuSuALLY AnxIOuS AnD THOSE WHO APPEAR PALE AnD SWEATY. These signs are indicators of possible shock. Recognizing these signs at the earliest possible moment will help you to identify this potentially serious condition early. In this case: 1. Recognizing anxiety, excessive sweat, and a pale appearance early will prompt you to look for other signs of shock as you complete your primary assessment, including observation of rapid pulse and respiratory rates. 2. Identification of shock will help you make the decision to classify the patient as unstable or potentially unstable and expedite your assessment and care. 3. Recognizing potential shock early will help you perform appropriate assessments later. In cases of suspected trauma, you will match this information with the mechanism of injury, the patient’s complaint, and assessment findings. In the medical patient, identifying shock may help you identify a body system to examine later (such as signs and symptoms of a heart attack).

• Obvious trauma to the head, chest, abdomen, or pelvis. Experienced EMTs identify serious trauma to these areas as injuries that can cause airway problems, profound shock or death. 1. Head injuries are serious because the brain is housed within the skull. Also, be-cause the head bleeds a lot when injured, the airway may require significant attention and care. 2. The integrity of the chest is vital fur breathing, When the chest is injured, normal adequate breathing may be disrupted by rib injury, collapsed lungs, and bleeding from the major blood vessels within the mediastinum. 3. The abdomen not only contains a rich blood supply, but it also contains many organs that may be injured during trauma 4. Injury to the pelvis can cause severe—and even fatal—bleeding • Specific positions indicate distress. The tripod position indicates significant difficulty breathing, whereas Levine’s sign indicates significant chest pain or discomfort. 1. Seeing either of these signs tells tw o things. The level of chest discomfort or respiratory distress is severe, and the patient’s complaints (cardiac and respiratory) are among the most serious medical complaints, indicating a high priority.

The Chief Complaint The chief complaint is the reason EMS was called, usually in the patient’s own words. It may be as specific as abdominal pain or as vague as “not feeling well.” In any case, it is the patient’s description of why you were called. You form a general impression by looking, listening, and smelling. You look for the patient’s age and sex—which are easy to determine once the patient is in sight, You look at the patient’s position to see if it indicates un injury , pain, or difficulty in breathing. You listen for sounds like moaning, snoring, or gurgling respirations. You sniff the air to detect any smells like hazardous fumes, urine, feces, vomit us. or decay. Something that is more difficult to describe than your direct observations but just as important is the feeling or sense you get when you arrive at the scene or encounter the patient. You may become anxious when you sec a patient who exhibits no outward signs of illness or injury, yet just doesn’t look right to you. Or you may feel reassured when you are dispatched to a sick baby, but see that the infant is alert and smiling. After you gain some practice assessing and managing patients, you may develop a “sixth sense” that clues you in to the severity of a patient’s condition. This is part of what is called clinical judgment, or judgment based on experience in observing and treating patients. Some people find it easier than others to cultivate this ability, but even those who have excellent clinical judgment do not depend on it alone. A systematic approach to finding threats to life is the best way to make sure they are not missed.

The clinical clues just listed arc not all-inclusive. There are many indications— some very subtle— that something is wrong with a patient. Something as seemingly simple as a statement that the patient “isn’t himself” may indicate a serious problem. You should also remember that these signs are only part of the information you will gather. You will find unstable patients who present with none of these signs and patients with very minor com-plaints who look serious. Most important, remember that the presence of any of these signs usually indicates a serious patient, but absence of these signs does not guarantee that the patient is stable.

Assess Mental Status Determining the patient’s mental status, or level of responsiveness, will usually be easy, since most patients are alert and responsive: that is, they are awake and will talk and answer questions sensibly. Some even if not awake, will still respond to verbal stimuli, such as talking or shouting. At a lower level of responsiveness, the patient will respond only to painful stimuli such as pinching a toe or ear or squeezing the trapezius muscle between the neck and the shoulder. The lowest and most serious status is unresponsiveness, when the patient will not respond even to a painful stimulus. An easy way to keep these levels of responsiveness in mind is by remembering the letters AvPu, for Alert, verbal response, Painful response, and unresponsive. A patient may be awake but confused. An awake patient’s mental status can be described by specifying what he is oriented to. Most EMS systems document orientation to person, place, and time. A patient who can speak clearly can almost always tell you his name (orientation to person). A few patients are oriented to person, but cannot tell you where they are (orientation to place). Some patients ate oriented to person and place but cannot tell you the time, day, or date (orientation to time). A few EMS systems include additional questions to determine orientation. A depressed mental status may indicate a life-threatening problem such as insufficient oxygen reaching the brain or shock If the level of responsiveness is lower than alert, provide highconcentration oxygen by nonrebreather mask and consider the patient a high transport priority. LIFELINE

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FOUNDATION OF EMT PRACTICE

Assess the ABCs

Breathing

You will always check the ABCs—airway, breathing, and circulation—as you look for life-threatening problems. Later in this chapter you will be introduced to four patients with various kinds of medical and traumatic complaints. You will see how the primary assessment differs for each of these patient types. Remember as you perform the primary assessment that there are two purposes: to identify and correct life threats with airway, breathing, and circulation and to gather information (e.g., indications of severity/ priority; signs of illness or injury) that will help you later in your assessment. You were introduced to the initial decisionmaking scheme earlier in the chapter. It shows an expanded view of the primary assessment. Remember that you will use the primary assessment components listed in the order that is most appropriate for your patient’s condition.

Airway If the patient is alert and talking clearly or crying loudly, you know that the airway is open. If the airway is not open or is endangered (the patient is not alert, is supine, or is breathing noisily). take measures to open the airway, such as the jawthrust or head-tilt, chin-lift maneuver, suctioning: or insertion of an oropharyngeal or nasopharyngeal airway. If the airway is blocked, perform clearance procedures.

Patient Is Apparently Lifeless 1. Look for signs of life including movement. Scan the chest for signs of breathing. If no signs of life such as breathing (or only gasping breathing) are found, check the pulse. 2. Check the pulse for no longer than 10 seconds. 3. If no pulse, begin CPR compressions while the defibrillator is being readied. 4. Clear the patient. Apply the defibrillator and follow the voice prompts. 5. Continue resuscitation. Multiple rescuers can handle multiple assessment task simultaneously.

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Once an open airway is ensured, assess the patient’s breathing. There are four general situations that call for assistance with breathing, listed here from more to less severe: • If the patient is in respiratory arrest, perform rescue breathing. • If the patient is not alert and his breathing is inadequate (with an insufficient minute volume because of decreased rate or depth or both), provide positive pressure ventilations with 100 percent oxygen. • If the patient has some level of alertness and his breathing is inadequate. Assist his ventilations with 100 percent oxygen. Synchronize your ventilations with the patients own respiration, so that they are working together, not against each other. • If the patient’s breathing Is adequate but there are signs or symptoms suggesting respiratory distress or hypoxia, provide oxygen based on the patients need as determined by your examination, the patient’s complaint, and the pulse oximetry readings.

Maaaring magbago ang paraan ng pagsusuri at pagtugon sa isang emergency depende sa klase ng pasyente. Halimbawa, iba ang paraan ng pagsusuri at pagtugon kapag bata ang pasyente; iba rin pag matanda. At iba rin kung may sugat o nalunod ang pasyente. Kung mas madami kayo sa grupo, mas makakapagbigay kayo ng iba’t ibang pagtugon nang sabay-sabay.

Patient with a Pulse 1. Develop a general impression and obtain a chief complaint. Take spinal precautions if trauma is suspected. 2. Open the airway. 3. Suction if necessary. 4. Insert an oral or nasal airway if required to maintain a patent airway. 5. Evaluate breathing for rate and depth. 6. Apply positive pressure ventilation to patients who are not breathing

or breathing inadequately. 7. Provide oxygen based on patient complaint, condition and pulse oximetry reading. 8. Identify and control life threatening bleeding. 9. Evaluate circulation. Check pulse 10. Evaluate circulation. Check skin color, temperature and conditions. 11. Make a status / transport priority decision. 12. Request ALS or other assistance necessary.

Part of the primary assessment includes correcting certain conditions you may find. Injuries to the chest can reduce the rate and depth of breathing and significantly impact the functioning of the lungs. Multiple broken ribs (called flail chest) and injuries that penetrate the chest, leaving an open wound, are examples of severe conditions you will look for. They are relatively easy to identify by observing and palpating the chest cavity. Although you won’t be taught how to care for these chest injuries until later in the book, for now remember that it will be important to look for these life-threatening conditions in the primary assessment.

Circulation Once breathing problems are corrected, assess the patient’s circulation. Begin by taking the patient’s pulse If the patient was lifeless on your initial approach you will have begun CPR at that point. Keep in mind, however, that cardiac arrest is not the only possible lifethreatening circulation problem. Inadequate circulation and severe blood loss are also life threatening. To evaluate circulation, assess pulse, skin, and bleeding. If the patient is lightskinned, you can check the pulse and skin at the same time. As you lake the radial pulse, note whether the skin at the wrist is warm. pink, and dry—indicating good circulation—or pale and clammy (cool and moist)—suggesting shock, which is a serious condition. If your patient is dark-skinned, you can check the color of the lips or nail beds, which should be pink. You don’t have to take the pulse for a full 30 seconds and obtain an exact rate. During the primary assessment, there are only three possible results of the pulse check that you’ will be looking for: • Within normal limits • unusually slow • unusually fast Anything other than normal is concerning and may indicate a serious condition. You will get used to different pulse rates as you practice. This will allow you to identify these three types of pulse rates easily—especially in combination with other things (example: a very rapid pulse in the presence of trauma or a very slow pulse in a patient who has chest pain, both indicating an unstable, high-priority patient). Also check for and control severe bleeding. If even one large vessel or several smaller ones arc bleeding, a patient can lose enough blood in just a minute or two to die. Quick control of severe external bleeding can be lifesaving. Transport decisions should take into account the potential for shock resulting from inadequate circulation and blood loss. Keep in mind that to perform a primary assessment, you must touch your patient. Even when you encounter an alert patient, you should still feel for a pulse, as well as for skin temperature and condition. These may help you identify shock early—a potentially lifesaving decision.

Determine Priority Any life-threatening airway, breathing, or circulation problem must be treated as soon as it is discovered. Once life threats are under control, you will decide on the patient’s priority for immediate transport versus further on-scene assessment and care. A useful approach to decision making is to classify a patient as stable, potentially unstable or unstable. Although there are few hard and fast rules for how to determine stability several principles will help you. • To be stable, a patient needs to have vital signs that are in the normal range or just slightly abnormal. If they are abnormal, they must be small deviations from normal or easily explained by factors other that injury and illness (e.g., sweating on a hot day). Stable vital signs are not the only requirement for a stable classification, but they are necessary. • A threat to the airway, breathing, or circulation, either actual or imminent, rules out stable. This puts a patient in either the unstable or potentially unstable category, depending on the severity of the patients condition. • There are many times when it is not crystal clear what a patient’s problem is, so there will be many possible diagnoses, some more serious than others. When a patient does not have any immediate threats to life, but you believe he may deteriorate because of the nature of the problem, you should consider the potentially unstable category for the patient. This means you will not delay transport, but it does not necessarily mean you will use lights and siren to transport the patient to the hospital. • A patient’s priority can change. For example, an unconscious diabetic patient with a low blood sugar would initially be unstable because of the threat to the airway. If the patient became awake enough to swallow oral glucose and then became alert and oriented, it would be appropriate to change this patient’s priority lo stable.

High-Priority Condition • Poor general impression • Unresponsive • Responsive, but not following commands • Difficulty breathing • Shock • Complicated childbirth • Chest pain consistent with cardiac problems • Uncontrolled bleeding • Severe pain anywhere

Although most patients do not need immediate transport, a few do. Therefore, you must be able to determine which patients fall into which category. If any lifethreatening problem cannot be controlled or threatens to recur, or if the patient has a depressed level of responsiveness, he has an immediate priority far transport to the hospital, with assessment and care continuing en route. A number of findings indicate a high priority for transport (i.e.. the patient is categorized as unstable or potentially unstable) These are conditions for which, usually, there is little or no treatment that can he given in the field that will make a difference in how well the patient does. You will learn more about these conditions in later chapters.

² Limmer (Brady) ³ Pollack, (AAOS) 4 NHTSA

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CRITICAL DECISION MAKING Determining Priority At the end of the primary assessment you will make a priority determination. This determination is a key decision that will affect the rest of your assessment and care. Patients deemed a high priority will receive a streamlined assessment process leading to prompt transport. Patients w ho arc not a high priority will receive their assessment and care at a slower (although not slow) pace. Patient assessment takes different forms, de pending on the following patient characteristics: • Whether the patient has a medical problem or trauma (Injury) • Whether the patient does or does not have an altered mental status • Whether the patient is an adult, a child, or an infant

Isang kakaibang bahagi ng pagsusuri sa pagdaloy ng dugo sa mga sanggol o bata ay ang capillary refill. Ang mga kuko ng isang malusog na sanggol o bata ay kadalasang kulay rosas. Kung pipisilin mo ito, magbabago ang kulay nito pero babalik din agad sa kulay rosas. Kadalasan, sa loob lamang ng 2 segundo. Sa mga bata, puwede mo itong gamitin para malaman kung maayos ba ang daloy ng dugo. Pagkapisil sa kuko, bumilang ng “one-one-thousand, two-onethousand.” Kapag bumalik agad sa kulay rosas ang kulay, normal ang daloy ng dugo ng bata. Kung hindi bumalik ito sa rosas pagkatapos mo magbilang, malamang na may problema sa sirkulasyon ng dugo ang bata.

Capillary refill is not a reliable sign for adults, so it is used only in infants and young children. In some adults, especially in the elderly, it is normal for capillary refill to take longer than 2 seconds. Even in infants and young children, capillary refill can be affected by factors such as the weather. Cold temperatures will prolong capillary refill. In other words, it should be used as one factor to consider in determining the priority of the young patient, but not the only one. Like adult trauma patients, child and infant trauma patients need to have their heads immobilized in order to prevent injury to the spinal cord. An infant has an airway that is different from an adult’s, so opening an infant’s or child’s airway means moving the head to a neutral position, not tilting It beck the way an adult’s airway is opened. The mental status of unresponsive infants is typically checked by talking to the infant and flicking the feet.

TABLE 11-2 Primary Assessments Steps and Interventions MEDICAL PATIENT RESPONSIVE

208

UNRESPONSIVE

1. General Impression: Form general impression of patient’s condition.

2. Mental Status: AVPU (Alert)

2. Mental Status: AVPU (responsive only to verbal or painful stimulus or not responsive) Intervention: High-concentration oxygen as soon as airway is open.

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TRAUMA PATIENT RESPONSIVE

UNRESPONSIVE

1. General Impression: Form general impression of patient’s condition. Evaluate mechanism of injury. Intervention: Manual stabilization of head and neck.

2. Mental Status: AVPU (alert)

2. Mental Status: AVPU (responsive only to verbal or painful stimulus or not responsive) Intervention: Highconcentration oxygen as soon as airway is open.

TABLE 11-2 Primary Assessments Steps and Interventions MEDICAL PATIENT RESPONSIVE

UNRESPONSIVE

TRAUMA PATIENT RESPONSIVE

UNRESPONSIVE

3. Airway is open.

3. Airway is compromised. Intervention: Open airway with head-tilt, chin-lift maneuver; consider nasopharyngeal airway; suction as needed. For foreign body obstruction, use abdominal thrusts or other blockage-clearing technique.

3. Airway is open.

3. Airway is compromised. Intervention: Open airway with head-tilt, chinlift maneuver; consider nasopharyngeal airway; suction as needed. For foreign body obstruction, use abdominal thrusts or other blockage-clearing technique.

4. Breathing: Look for rise and fall of chest, listen and feel for the rate and depth of breathing. Look for work of breathing (use of accessory muscles, retractions). Interventions: If there is hypoxia, respiratory distress, or threat to the airway, ventilation, oxygenation, or circulation, administer high-concentration oxygen by nonbreather mask. If breathing becomes inadequate, provide positive pressure ventilation and high-concentration oxygen.

4. Breathing: Look for rise and fall of chest, listen and feel for rate and depth of breathing. Look for work of breathing (use of accessory muscles, retractions). Interventions: If there is hypoxia, respiratory distress, or threat to the airway, ventilation, oxygenation, or circulation, administer highconcentration oxygen by nonrebreather mask. Position patient on side, If breathing is inadequate, provide positive pressure ventilations and high-concentration oxygen. If respiratory arrest develops, perform rescue breathing.

5. Circulation: Pulse; bleeding; skin color, temperature condition (capillary refill in infants and children under 6). Interventions: control bleeding. Treat for shock. If cardiac arrest occurs, perform CPR.

4. Breathing: Look for rise and fall of chest, listen and feel for rate and depth of breathing. Look for work of breathing (use of accessory muscles, retractions). Expose and palpate the chest for signs of trauma that will affect breathing Interventions: If there is hypoxia, respiratory distress, or threat to the airway, ventilation, oxygenation, or circulation, administer highconcentration oxygen by nonrebreather mask. Position patient on side once spinal stability is assured. If breathing is inadequate, provide positive pressure ventilations and high-concentration oxygen. If respiratory arrest develops, perform rescue breathing.

6. Priority: A responsive patientâ&#x20AC;&#x2122;s priority depends on chief complaint, status of ABCs, and other factors.

6. Priority: An unresponsive patient is automatically a high priority for immediate transport.

6. Priority: A responsive patientâ&#x20AC;&#x2122;s priority depends on chief complaint, status of ABCs, and other factors.

6. Priority: An unresponsive patient is automatically a high priority for immediate transport.

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TABLE 11-3 Primary Assessments of Adult, Children, and Infants ADULTS CHILDREN 1-5 YEARS

210

INFANTS TO 1 YEAR

Mental Status

AVPU: Is patient alert? Responsive to verbal stimulus? Responsive to painful stimulus? Unresponsive? If alert, is patient oriented to person, place, and time?

As for adults.

If not alert, shout as a verbal stimulus, flick feet as a painful stimulus. (crying would be infantâ&#x20AC;&#x2122;s expected response.)

Airway

Trauma: Jaw-thrust maneuver. Medical: head-tilt, chin-lift maneuver. Both: Consider oro-or nasopharyngeal airway, suctioning.

As for adults, but see Chapter 8 and BCLS Review for special child airway techniques. If performing head-tilt, chin-lift maneuver, do so without hyperextending (stretching) the neck.

As for children, but see Chapter 8 and BCLS Review for special infant airway techniques.

Breathing

If respiratory arrest, perform rescue breathing. If depressed mental status and inadequate breathing (slower than 8 per minute), give positive pressure ventilations with 100 percent oxygen. If alert and respiration are more than 24 per minute, give 100 percent oxygen by nonrebreather mask.

As for adults, but normal rates for children are faster than for adults. (See chapter 12 for normal child respiration rates.) Parent may have to hold oxygen mask to reduce childâ&#x20AC;&#x2122;s fear of mask.

As for children, but normal rates for infants are faster than for children and adults. (See Chapter 12 for noirmal infant respiration rates.)

Circulation

Assess skin, radial pulse, and bleeding. If patient is in cardiac arrest, perform CPR. See Chapter 27 on how to treat for bleeding and shock.

Assess skin, radial pulse, bleeding and capillary refill. See Chapter 12 for normal child pulse rates (faster than for adults). If patient is in cardiac arrest, perform CPR. See Chapter 27 on how to treat for bleeding and shock.

Assess skin, brachial pulse, bleeding, and capillary refill. See Chapter 12 for normal child pulse rates (faster than for children and adults). If patient is in cardiac arrest, perform CPR. See BCLS review for special infant techniques. See chapter 27 on how to treat for bleeding and shock.

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SECONDARY ASSESSMENT OF MEDICAL PATIENT LEARNING OBJECTIVES • Describe and demonstrate the unique needs for assessing an individual with a specific chief complaint with no known prior history. • Differentiate between the history and physical exam that are performed for responsive patients with no known prior history and responsive patients with a known prior history.

Ang susi sa paglipat mula sa primary assessment patungo sa secondary assessment ay ang uri ng disgrasya na dinanas ng pasyente pati na rin ang anumang sakit na iniaaangal nito. Kung may nakikita kang injury sa pasyente, kailangan mong magsagawa ng karagdagang pagsusuri. Ganundin kung may inirereklamo pang sakit ang pasyente na hindi mo nakita sa iyong unang pagsusuri. Sa chapter na ito matututunan mo kung papaano magsagawa ng secondary assessment.

SECONDARY ASSESSMENT OF THE MEDICAL PATIENT Responsive Medical Patient As you learned in previous topic, “The Primary Assessment.” it makes a great deal of difference in the assessment process whether the patient is responsive or un responsive. This is especially true of the medical patient. In trauma patients, there are often many external signs of trauma, or injury, hut this is not true of a patient with a medical condition. The most important source of information about a medical pattern’s condition is what the patient can tell you. This is why. when the patient is awake and responsive, obtaining the patient’s history comes first. A good example of the kind of patient you will see often is one who is awake and has a medical problem with no immediately life-threatening problems. After you finish the primary assessment for this patient, perform a secondary assessment. This will tell you what you need to know in order to administer the proper treatment. The secondary assessment for a medical patient has four parts: history of the present illness, past medical history, physical exam and baseline vital signs.

Take a History of the Present Illness The interview you do with it patient is similar to the interview a physician conducts before a physical examination. It is a conversational information-gathering effort. not only will you gain needed information from the interview, hut you will also reduce the patient’s fear and promote cooperation. Although relatives and bystanders may serve as sources of information, the most important source is the patient. Do not interview relatives and bystanders before you interview the patient unless the patient is unconscious or unable to communicate. You may gain information from bystanders and medical identification devices later, while you are conducting the physical examination. One purpose of talking to the patient is to find out his chief complaint, the one thing that seems most seriously wrong to him. When you ask the patient what is wrong, he may tell you that several things are bothering him. If this happens, ask what is bothering him most. Find out if the patient is in pain and where he hurts. unless the pain of one injury or medical problem masks that of another, most people will he able to tell you of painful areas.

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Try to ask open-ended questions, or questions that the patient answers with responses other than “Yes” or “no.” For example, do not ask, “Is your chest pain dull and crushing?” Ask instead.”How would you describe your pain?” In this way. you will avoid giving the patient the impression that you want a particular answer. If the patient says that he cannot describe his pain, you can try giving him several choices: “Is your pain dull, or sharp, or burning?”

The key to moving from the primary assessment into the secondary assessment is reconsideration of the mechanism of injury as well as of the patient’s complaint If there is a mechanism of injury or actual injury, you will perform the secondary assessment for the trauma patient, which was described in topic, “Assessment of the Trauma Patient.” When the patient has a complaint that is medical in nature, and you have confirmed that there is no significant mechanism of injury or actual injury, you will perform the secondary assessment for the medical patient— the subject of this chapter.

TABLE 14-1 Assessment of the Responsive and Unresponsive Medical Patient RESPONSIVE MEDICAL PATIENT

UNRESPONSIVE MEDICAL PATIENT

1. Gather the history of the illness (OPQRST) from the patient: Onset Provokes Quality Radiation Severity Time

1. Conduct a rapid physical exam: Head Neck Chest Abdomen Pelvis Extremities Posterior

2. Gather a past medical history from the patient: Allergies Medications Pertinent past history Last oral intake Events leading to the illness

2. Obtain baseline vital signs: Respirations Pulse Skin Pupils Blood pressure Oxygen saturation*

3. Conduct a physical exam (focusing on the area the patient complains about).

3. Gather the history of the present illness (OPQRST) from family or bystanders: Onset Provokes Quality Radiation Severity Time

4. Obtain baseline vital signs: Respiration Pulse Skin Pupils Blood pressure Oxygen saturation*

4. Gather a past medical history from bystanders or family: Allergies Medication Pertinent past history Last oral intake Events leading to the illness

*As directed by local protocol

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This table shows the general order of steps. You may alter this order in accordance with the situation and the number of EMTs available and when the patient’s condition warrants immediate actions due to immediate life threats PREHOSPITAL EMERGENCY CARE

Examination of the Responsive Medical Patient 1. HISTORY OF PRESENT ILLNESS. Ask the OPQRST questions: • Onset • Provokes • Quality • Radiation • Severity • Time

An easy way to remember most of the questions you will ask to obtain a history of the present illness is to use the letters OPQRST:

• Onset. What were you doing when it started? • Provokes. Can you think of anything that might have triggered this pain?

• Quality. Can you describe ii for me? • Radiation. Where exactly is the pain? Does it seem to •

2. PAST MEDICAL HISTORY.

Ask the SAMPLE questions; • Signs and symptoms • Allergies • Medications • Pertinent past history • Last oral intake • Events leading to the illness

3. PHYSICAL EXAM.

Perform a quick assessment of the affected body part or system: • Head • neck • Chest • Abdomen • Pelvis • Extremities • Posterior

4. VITAL SIGNS.

Assess the patient’s baseline vital signs: • Respiration • Pulse • Skin color, temperature, condition (and capillary refill in infants and children) • Pupils • Blood pressure • Oxygen saturation (if appropriate for the patient’s chief complaint)

5. INTERVENTIONS AND TRANSPORT.

Perform interventions as needed and transport the patient. Contact on line medical direction as needed-

•

spread anywhere or does it right there? Severity. You look uncomfortable. How had is the pain? If zero was no pain and 10 was the worst pain you can imagine, what number would you assign to your pain? (use the system of determining pain severity recommended by local protocols.) Time. When did the pain start? Has it changed at all since it started?

You should also inquire about accompanying conditions. For example, a patient with severe chest pain may be so apprehensive that he doesn’t tell you about his moderate shortness of breath until you ask him about it specifically. There are certain chief complaints that by their nature suggest the possibility of other symptoms This chapter will describe some of the more common ones.

Take a Past Medical History After finding out the patient’s age. you should then gel the rest of the past medical history and the name of his personal physician. using the SAMPLE letters, as defined in topic “Assessment of the Trauma Patient,” the “S” (symptoms) were explored during the history of the present illness, as just described. (Signs will be discovered during the physical exam and vital signs measurements.) For the past medical history, continue with the rest of the SAMPLE questions, as follows:

• Allergies. Are you allergic to anything? • Medications. What medicines do you take? What do you • • •

take those for? Are there any other medicines you are supposed to take, but don’t? Pertinent past history. Do you have any other medical problems? Have you ever had this kind of problem before? Who is your doctor? Last oral Intake. When was the last time you ate or drank anything? What did you eat or drink? Events leading to the illness. How have you felt today? Have you experienced anything out of the ordinary?

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Tailoring the Physical Exam for Specific Chief Complaints If you obtain the history of the present illness and the past medical history as they have been described up until now. you will obtain a great deal of information Many times, however, you can gain additional important information by tailoring the history to the patient’s chief complaint. This means asking questions pertinent to that complaint. BODY SYSTEMS APPROACH. You learned in earlier chapters that discussed anatomy, physiology, and pathophysiology about the different systems of the body and how they work. Part of the reason for studying anatomy, physiology, and pathophysiology is to be able to use this knowledge lo guide your assessment. When an illness or other non traumatic condition occurs, it frequently affects not just one particular organ or part of the body but a system of the body. For example, when you get an upper respiratory infection, you may have signs and symptoms related to the nose, throat, and chest. These are all part of the respiratory system. Sometimes more than one body system may be affected, as when problems with the respirators’ system affect the cardiovascular system or vice versa. To get the most information about the medical patient’s problem, you should focus your questioning and physical examination of the medical patient on the particular body system or systems most likely to be involved.

Maging mapanuri sa iyong pagtatanong. Kung ang pasyente ay hirap huminga, itanong mo rin kung siya ay may lagnat, may sipon at ubo, o giniginaw. Ang kondisyon niya kasi ay posibleng simtomas lang ng isang mas malubhang sakit.

For example, if a patient is having difficulty breathing, you should inquire about whether the patient has had a fever or chills (which can be associated with pneumonia) or a cough (which can be associated with not just pneumonia, but also upper respiratory* infections, asthma, cystic fibrosis, and many other conditions). You should also ask whether the patient’s physician has prescribed an inhaler for the patient. This may significantly affect the treatment you administer. However, with the patient who complains of difficulty breathing you should also consider the cardiovascular system. You will learn that difficulty breathing is often a sign of heart attack. When assessing a patient with difficult breathing you should also assess for signs of fluid build-up (this may be seen in the ankles—or in the lower back of a bedridden patient). You should ask about chest pain or discomfort as well as other signs that the heart could be involved in the breathing difficulty. Altered mental status is a complaint that could be associated with many body systems. If the patient has an altered mental status, you may assess the endocrine system for blood sugar problems, the neurological system for signs of a stroke, and possibly other systems, depending on the patient’s presentation. There are many other questions you can and should ask when gathering a history for certain conditions

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TABLE 14-2 Secondary Assessment: Specific Medical Complaints TYPE OF COMPLAINT

ADDITIONAL HISTORY

PHYSICAL EXAM

Respiratory

Cough Fever or chills Dyspnea on exertion Weight gain (indicates fluid) Have a prescribed bronchodilatior?

Lung sounds (presence and equality) Wheezing Work of breathing and position Pulse oximetry (oxygen saturation)

Cardiovascular (cardiac and respiratory system closely related)

Have prescribed nitroglycerin? Taking aspirin?

Skin color, temperature, and condition Blood pressure Pulse (including strength and regularity) Lung sounds (presence and equality) Jugular vein desterition Ankle edema Oxygen saturation

Neurological

Headache Seizure

FAST (Face-Arm-Speech-Test --includes components of the Cincinnati Prehospital Stroke Scale) FACE-does one side of the patient’s lace droop(ask the patient to smila) ARMS – can the patient hold both arms in front of him? SPEECH – is the patient speech clear and understandable? TEST – oxygen saturation

Allergic (involves components of the cardiovascular and respiratory system)

Time of exposure Time of symptom onset

Stinger Hives (urticaria) Lung sounds (presence and equality) Face and neck edema Oxygen saturation

Abdominal/ gastrointestinal

Fever Nausea and vomiting Diarrhea or constipation Blood in vomit or bowel movements: May be bright red(fresh) or dark (digested) Menstrual history

Inspect and palpate all four quadrants of the abdomen

Endocrine

Oral intake Medication history History of recent illness Excessive hunger, thrist, urination

Blood glucose monitoring Skin color, temperature, and condition Mental status Unusual breath odors

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Check for symmetry

UNIT 22 UNIT DAY 99 DAY Unit 2

MANDIBLE/ MAXILLA 1. NOSE feel BRIDGE both mandible and 1. maxilla hold the and pinch for nose any deformity lightly to feel if there’s and tenderness. Check for a broken bone still symmetry and or if itif it is isstill intact. intact.

FUNDAMENTALS OF EMT PRACTICE Day 9

SECONDARY ASSESSMENT

Perform aa Physical Physical Exam Exam Perform

Perform a Physical Exam

CHEEKS 1. hold both cheeks and HEAD: With responsive medical patients the EMT's physical exam is usually brief. brief. You You will will HEAD: With responsive medical patients the EMT's physical exam is usually lightly feel the contour 1. BSI BSI on. on. Inspect Inspect the the head head gather most of the important assessment information in Ml type of patient from 1. most of the important assessment information in Ml typeand of patient from any deformity or if With responsive the EMT’sgather physical exam and medical palpate patients from front front the history history and and vital vital signs. signs. There There are are lists lists of of some some of of the the physical physicalthere’s exam steps steps you and palpate ititmost from the exam you any tenderness . BSI on. Inspect the head and palpate is usually brief. You will gather of the important assessment going to to back. back. Stroke Stroke the the should take take when when evaluating evaluating patients patients with with certain certain chief chief complaints. complaints. For example, going should For example, Check for symmetry it from front going to back. Stroke information in Mlhead type ofand patient andpatient vital signs. feelfrom for the anyhistory your has difficulty difficulty breathing, breathing, you you should should listen to to the the patient's patient's chest chest with head and feel for any ifif your patient has theand head and feelofforlisten any deformity orIf you havewith There are lists of some of the physical exam steps you should take deformity or abnormal a stethoscope for the presence equality breath sounds. redeformity or abnormal MANDIBLE/ a stethoscope for the presence and equality of breath sounds. If you MAXILLA have refindings and check when evaluating findings patients For example, findings with andcertain checkchief for complaints. ceived additional additional education on onabnormal recognising specific typesfor of1.blood. breath sounds, you and check for feel sounds, both mandible and ceived education recognising specific types of breath you Check for symmetry. blood. Check for symmesymmeif your patient hasblood. difficulty breathing, you should listen to the to should attempt to do do so. so. For For aa patient patient who at risk risk for for hypoxia, hypoxia, maxilla like this this one, one,any youdeformity Check for for should attempt who isis at like you try.a stethoscope for the presence patient’s chest with and equality should also check check oxygen oxygen saturation. saturation. IfIf your your patient patient has has aa complaint complaint that does not notCheck for andthat tenderness. try. should also does fiteducation into any any of of the the categories categories you you learned learned in in your your EMT EMT course, course, you you shouldand focus of breath sounds. If you have received additionalfit on symmetry if it is still into should focus EYES types of breath sounds, youthe the exam on the the body body part part that that the the patient patient has has aa complaint complaint about. about. For example, example, ifif intact. recognising specific should attempt EYES exam on For Using your thumb follow the contour 1. usingwho your thumb follow the patient complains of thigh thigh pain, pain, you you will will inspect inspect and and palpate palpate his his thigh. thigh. AlAlto do so. For 1. a patient is at risk for hypoxia,the likepatient this one, you using your thumb follow complains of of the eyecan andtake browinarea and check for most the contour of the eye though there are a few other steps you the physical exam, of the contour of theIf your eye patient should also checkthe oxygen saturation. hasthere a complaint though are a few other steps you can take in the physical exam, most of the any deformity or alteration from normal. andany brow areacategories and check check useful information information in medical medical patients patients comes from from the history. history. and brow area and useful comes the that does not fit into of the you learned in your EMTin Check for symmetry. for any any deformity deformity or or alfor course, you should focus the exam on thealbody part that the patient teration from from normal normal .. teration has a complaint about. For example, if the patient complains of thigh Check for for symmetry symmetry HEAD Check HEAD pain, you will inspect and palpate his thigh.

HEAD:

EYES:

Although there are a few other steps you can take in the physical exam, most of the useful information in medical patients comes from the history.

Kapain ang ulo kung may hindi tamang porma dito o may dugo. Tingnan din ang mga mata yung may hindi tamang porma. Suriin kung pantay ba ang ulo at ang mga mata.

UNIT DAY

HEAD EYES EYES

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² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³⁴Pollack, NHTSA(AAOS) ⁴ NHTSA

NECK 1. check the neck area, carefully not to palpate the carotid pulse located at each side of the neck. Check for any laceration, lumps , or any abnormalities. From front to back and sides

T2 Y9

there’s any tenderness . Check for symmetry MANDIBLE/ MAXILLA CHEEKS NOSE BRIDGE 1. feel both mandible

CHEEKS

and maxilla for any deformity and tenderness. Check for symmetry and if it is still intact.

NOSE BRIDGE

CHEEKS MANDIBLE/MAXILLA CHEEKS

MANDIBLE/MAXILLA

NOSE BRIDGE

Hold the nose and pinch lightly to feel if there’s a broken bone or if it is still intact.

CHEEKS

Hold both cheeks and lightly feel the contour and any deformity or if there’s any tenderness . Check for symmetry

MANDIBLE/MAXILLA

MANDIBLE/ MAXILLA

Feel both mandible and maxilla for any deformity and tenderness. Check for symmetry and if it is still intact.

FUNDAMENTALS OF EMT PRACTICE

Suriin din ang ilong kung may bali bang buto. Kapain din ang mukha kung may nabugbog ba o may hindi tamang porma. At suriin ang panga kung pantay o may parte na nabugbog o dumudugo.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

MANDIBLE/MAXILLA NECK LIFELINE

PREHOSPITAL EMERGENCY CARE

217

palpate the located at the neck. y laceration, y abnormaliont to back

side side of of chest. chest. Repeat Repeat thisthis step step to to check check thethe lover lover part part of of thethe chest. chest.

1. 1. check check the the neck neck area, area, carecarefully fullynot nottotopalpate palpatethe the carotid carotidpulse pulselocated locatedat at each eachside sideofofthe theneck. neck. Check Checkforforany anylaceration, laceration, lumps lumps , or , or any any abnormaliabnormalities. ties.From Fromfront fronttotoback back and and sides sides

RIBS 1. put your 8 fingers at the RIBSRIBS sternum, using those, slightly 1. put 1. put your your 8 fingers 8 fingers at at thethe the upper chest for sternum, SECONDARY ASSESSMENT Daypalpate 9 sternum, using using those, those, slightly slightly NECK NECK any broken ribs, tenderness palpate palpate thethe upper upper chest chest for for and deformity going to each anyany broken broken ribs,ribs, tenderness tenderness side of chest. Repeat this step andand deformity deformity going going to to each each to check the lover part of the sideside of chest. of chest. Repeat Repeat thisthis stepstep chest. to check to check thethe lover lover partpart of the of the chest. chest.

NECK

Check the neck area, carefully not to palpate the carotid pulse located at each side of the neck. Check for any laceration, lumps , or any UNIT 2 abnormalities. DAY 9 From front to back UNIT 2 DAY 9 and sides. SHOULDER/ CLAVICLE 1. from the neck slide your SHOULDER/ CLAVICLE hand downward going to 1. the from the neck slide and your patient’s shoulder hand downward to clavicle. Check for going symmethedeformity, patient’s shoulder and try, tenderness, clavicle. etc. Check for symmewounds try, deformity, tenderness, wounds etc. STERNUM 1. place the side of your STERNUM hand on top of your pa1. tient’s place sternum the side of cenyour at the hand topchest. of yourStart pater of onthe tient’s sternum at thefrom cenpressing the sternum ter pinky of the the sidechest. at topStart of pressing the going sternum the sternum to from the the near pinkyyour sidewrist, at top side do of it the sternum going to the until ² Limmer (Brady) you cover the entire ³ Pollack,side (AAOS) near your wrist, do it sternum. Look and feel for ⁴ NHTSA until you or cover the entire deformity broken part, sternum. Look and and feel for tenderness any deformity or broken part, wounds Suriin ang leeg, tenderness and any ang balikat, wounds at ang

FUNDAMENTALS OF EMT PRACTICE FUNDAMENTALS OF EMT PRACTICE SHOULDER/ CLAVICLE

NECK

SHOULDER/ CLAVICLE

² Limmer (Brady) ² Limmer (Brady) ³ Pollack, (AAOS) ³ Pollack, (AAOS) ⁴ NHTSA ⁴ NHTSA

UNIT UNIT 2 2 DAY DAY 9 9

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

SHOULDER/ CLAVICLE

From the neck slide your hand downward going to the patient’s shoulder and clavicle. Check for symmetry, deformity, tenderness, wounds etc.

² Limmer ² Limmer (Brady) (Brady)

³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

dibdib ng pasyente kung merong hindi tamang porma o sa tingin mo ay may diprensya.

SHOULDER/CLAVICLE STERNUM STERNUM STERNUM

Place the side of your hand on top of your patient’s sternum at the ² Limmer (Brady) center of the chest. Start ³ Pollack, (AAOS) ⁴ NHTSA the sternum from pressing the pinky side at top of the sternum going to the side near your wrist, do it until you cover the entire sternum. Look and feel for deformity or broken part, tenderness and any wounds.

³ ⁴

ABDOMEN ABDOMEN (AUSCULTATION) (AUSCULTATION)

follow the the IAPP IAPP assessassessSTERNUM1. 1.follow 218

LIFELINE

PREHOSPITAL EMERGENCY CARE ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ ² NHTSA Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

m emn et n t p r o p cr oe cd eu dr e ure (Inspection, (Inspection, auscultation, auscultation, percussion percussion andand palapapalapation). tion). Auscultation Auscultation is done is done prior prior palpation palpation to not to not dis- dis² Limmer (Brady) ³ Pollack, (AAOS)

² Lim ³ Pol

RIBS RIBS RIBS

FUNDAMENTALS FUNDAMENTALS OF OF EMT EMT PRACTICE PRACTICE UNIT 22 UNIT DAY 99 DAY

RIBS

put your 8 fingers at the sternum. Using those, slightly palpate the upper chest for any broken ribs, tenderness and deformity going to each side of chest. Repeat this step to check the lower part of the chest.

FUNDAMENTALSOF OFEMT EMTPRACTICE PRACTICE FUNDAMENTALS

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

Limmer ² Limmer (Brady) (Brady) Pollack, ³ Pollack, (AAOS) (AAOS) NHTSA ⁴ NHTSA

ABDOMEN (AUSCULTATION) ABDOMEN 1. follow (AUSCULTATION) the IAPP assess1. follow m e n t thep rIAPP o c e dassessure m ent p rauscultation, ocedure (Inspection, (Inspection, auscultation, percussion and palapapercussion and ispalapation). Auscultation done tion). Auscultation is done prior palpation to not disturb palpation the abdominal prior to not gas dispresent its charturb thebecause abdominal gas acteristicbecause might its change present charonce the abdomen is palacteristic might change patedthe andabdomen will giveis you once palfalse orand modified resultyou or pated will give assessment false or modified result or mmer ² Limmer (Brady) (Brady) Use a stethoscope when llack, ³2. Pollack, (AAOS) (AAOS) assessment

RIBS

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

ABDOMEN (AUSCULTATION) ABDOMEN (AUSCULTATION)

ABDOMEN ABDOMEN (AUSCULTATION) (AUSCULTATION)

Gamitin ang walong daliri para sa pagsusuri sa dibdib ng pasyente. Kapain kung may nabaling buto sa harap at gilid ng dibdib. Ulitin ang ganitong pagsusuri sa ibaba ng dibdib.

LIFELINE

PREHOSPITAL EMERGENCY CARE

219

ABDOMEN (AUSCULTATION) 1. follow the IAPP assessment procedure (Inspection, auscultation, percussion and palapation). Auscultation is done 1. Follow the IAPP prior palpation to not disturb assessment the abdominal gas procedure present becauseauscultation, its char(Inspection, acteristic might percussion and change oncepalapation). the abdomen is palAuscultation patedis done and prior will give to you false palpation or modified so asresult not toor assessment disturb the abdominal 2. Use a stethoscope when gas present because doing the auscultation, characteristic start its from the upper quadonce the rant might goingchange to the lower abdomen is palpated quadrant, take noteUNIT ofUNIT the2 2 will give you false gas and characteristic and DAY DAY 99 or modified result or duration.

Day 9

ABDOMEN (AUSCULTATION)

UNIT UNIT22 DAY DAY99

FUNDAMENTALS FUNDAMENTALSOF OFEMT EMTPRACTICE PRACTICE

ABDOMEN ABDOMEN(PALPATION) (PALPATION)

UNIT UNIT 2PRACTICE 2PRACTICE 1.1. using usingOF the the pads pads ofof your your FUNDAMENTALS FUNDAMENTALS OF EMT EMT FUNDAMENTALS FUNDAMENTALSOF OFEMT EMTPRACTICE PRACTICE fingers, fingers,palpate palpateeach eachababDAY DAY 99

dominal dominal quadrants quadrants by by pressing pressing down down the the area area gently gently and and pushing pushing itit slowly, slowly, observe observe for for any any reactions reactionsfrom fromthe thepatient patient ABDOMEN ABDOMEN (PALPATION) (PALPATION) like likepain painduring duringand andafter after palpation, palpation, take take note note ofof tenderness tendernessand andrigidity rigidity

ABDOMEN ABDOMEN (PALPATION) (PALPATION) 1. 1.using using thethe pads pads of of your your fingers, fingers, palpate palpate each each ab-abdominal dominalquadrants quadrantsby by pressing pressing down down thethe area area gently gentlyand andpushing pushingit it slowly, slowly,observe observeforforanyany reactions reactions from from thethe patient patient likelike pain pain during during and and after after palpation, palpation, take takenote noteof of ABDOMEN ABDOMEN (PALPATION) (PALPATION) tenderness tenderness andand rigidity rigidity

ABDOMEN ABDOMEN (PALPATION) (PALPATION) 3.

FUNDAMENTALS FUNDAMENTALS OFOF EMT EMT PRACTICE PRACTICE

reactions reactions from from thethe patient patient likelike pain pain during during andand after after palpation, palpation,take takenote noteof of tenderness tenderness andand rigidity rigidity

ABDOMEN ABDOMEN (PALPATION) (PALPATION) 1. 1. using using the the padspads of your of your fingers, fingers, palpate palpate eacheach ab- abdominal dominalquadrants quadrantsby by pressing pressing down down the the areaarea gently gently andpakinggan and pushing pushing it it Unahing slowly, slowly, observe observe for for any any ang katawan ng biktima reactions reactions fromfrom the the patient patient like like painpain during during andand afterafter bago ito kapain. palpation, palpation, taketake notenote of of Gumamit ng stethoscope tenderness tenderness andand rigidity rigidity

N NET TO1 1.

ABDOMEN ABDOMEN(PALPATION) (PALPATION)

assessment.

2. Use a stethoscope when doing the auscultation, start from the upper quadrant going to ABDOMEN ABDOMEN (PALPATION) (PALPATION) 1. 1. using using thethe pads pads of of your your the lower quadrant, fingers, fingers, palpate palpate each each ab-abtake note quadrants ofquadrants theUNIT gas UNIT dominal dominal by2by 2 pressing pressing down down thethe area area characteristic and DAY DAY 9 9 gently gentlyandandpushing pushingit it duration. slowly, slowly, observe observe for for anyany

SECONDARY ASSESSMENT

P PEL 1 1.

ABDOMEN (AUSCULTATION) 5.

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

sa pakikinig.

ABDOMEN (PALPATION)

using the pads of your fingers, palpate each abdominal quadrants by pressing down the area gently and pushing it slowly, observe for any reactions from the patient like pain during and after palpation, take note of tenderness and rigidity ² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

220

LIFELINE

F T 1

PREHOSPITAL EMERGENCY CARE ² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

² Limmer ² Limmer (Brady) (Brady) ³ Pollack, ³ Pollack, (AAOS) (AAOS) ⁴ NHTSA ⁴ NHTSA

PELVIS(HIP) (HIP) PELVIS

PELVIS LVISlocate the pelvic bone 1. locate with the your pelvic two bone hands, with twotenderness, hands, checkyour for any check for any tenderness, deformity and symmetry. deformity and the symmetry. Do not rock pelvis for Doit not pelvisinjury for will rock add the further it especially will add iffurther injury it is broken. especially if it is broken.

NEAREST LOWER EXTREMITY EAREST LOWER EXTREMITY TO RESCUER O1.RESCUER start with the thigh closer start with Hold the thigh closer to you. it with your tohand you. on Hold with youron topitthe other hand top thedirection other onto the on opposite the opposite direction to check for bone continuity check bone continuity and for deformity, check for and deformity,swelling check for tenderness, and tenderness, swellingDoand possible wounds. this possible wounds. Do thigh. this for all sides of the forFrequently all sides of check the thigh. your Frequently checkthat your gloves for blood indigloves bloodbleeding. that indicates for possible possible bleeding. 2. cates Using the palm of your Using of your hand,the cuppalm the knee and hand, theintact kneeorand checkcup if its if it check its intact or if it has aif deformity, swelling has a deformity, swelling or tenderness. tenderness. 3. orCheck the leg nearest you Check nearest you with the thelegsame manner with manner donethe withsame the thigh. with thigh. 4. done Check forthethe ankle conCheck for the tour and noteankle any condeviatour any check devia- if tionand fromnote normal, tion from deformity normal, check if there’s and/or there’s deformity and/or swelling. Check for Range swelling. Check for Range of Motion (ROM) Motion (ROM) 5. ofCheck the feet for PMS Check the feet for PMS Suriin ang beywang

ng pasyente. Ikutin ito nang dahan-dahan paa malaman kung may injury. Huwag itong alugin nang bigla o malakas dahil baka lalo lang makasama sa pasyente. Suriin din ang mga tuhod, sakong at mga daliri sa paa ng pasyente kung may UNIT 2 injury.

DAY 9

FARTHEST LOWER EXTREMITY TO RESCUER 1. start with the thigh distal to you. Hold it with your hand on top the other on the opposite direction to check for bone continuity and deformity, check for tenderness, swelling and possible wounds. Do this for all sides of the thigh. Frequently check your gloves for blood that indicates possible bleeding. 2. Using the palm of your hand, cup the knee and check if its intact or if it has a deformity, swelling

PELVIS

Locate the pelvic bone with your two hands, check for any tenderness, deformity and symmetry. Do not rock the pelvis for it will add further injury especially if it is broken.

NEAREST LOWER EXTREMITY TO RESCUER PELVIS (HIP) NEAREST LOWER EXTREMITY TO RESCUER NEAREST LOWER EXTREMITY TO RESCUER

FUNDAMENTALS OF EMT PRACTICE

1. Start with the thigh closer to you. Hold it with your hand on top the other on the opposite direction to check for bone continuity and deformity, check for tenderness, swelling and possible wounds. Do this for all sides of the thigh. Frequently check your gloves for blood that indicates possible bleeding. 2. Using the palm of your hand, cup the knee and check if its intact or if it has a deformity, swelling or tenderness. 3. Check the leg nearest you with the same manner done with the thigh. 4. Check for the ankle contour and note any deviation from normal, check if there’s deformity and/ or swelling. Check for Range of Motion (ROM) 5. Check the feet for PMS

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA ² Limmer (Brady)

³ Pollack, (AAOS) ⁴ NHTSA

NEAREST LOWER EXTREMITY TO RESCUER FARTHEST LOWER EXTREMITY TO RESCUER LIFELINE

PREHOSPITAL EMERGENCY CARE

221

FARTHEST LOWER

NEAREST UPPER EXTRE TO RESCUER SECONDARY ASSESSMENT Day 9 1. start with the arm to you. Hold it with EXTREMITY TO RESCUER hand on top the oth the opposite directio check for bone cont and deformity, chec FARTHEST LOWER EXTREMITY tenderness, swelling TO RESCUER possible 1. Start with the thigh distal to you. wounds. Do for allthesides of the t Hold it with your hand on top Frequently check other on the opposite direction to check for bone continuity and deforgloves for blood that mity, check for tenderness, swelling cates possible bleedin and possible wounds. this for the all palm of 2. DoUsing sides of the thigh. Frequently check hand, cup the elbow your gloves for blood that indicates check if its intact o possible bleeding. has a deformity, sw 2. Using the palm of your hand, cup the or tenderness. knee and check if its intact or if it 3. Check the forearm ne has a deformity, swelling or tenderyou with the same ness. nerwith done 3. Check the leg farthest you the with the ar same manner done4.withCheck the thigh.for the wrist 4. Check for the ankle contour tour and and note any d note any deviation fromtion normal, from normal, ch check if there’s deformity and/or deformity a there’s swelling. Check for Range of MotionCheck for R swelling. (ROM). of Motion (ROM) 5. Check the feet for PMS. 5. Check the hands for

Kapain ang paa at kamay ng pasyente para malaman kung may bali ba o namamaga ang mga ito. Sa mga kababaihan, posibleng magkamanas ang paa at sakong dahil sa Premenstrual Syndrome o PMS. normal lamang ito at hindi dapat ikabahala.

FARTHEST LOWER EXTREMITY TO RESCUER ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

222

LIFELINE

PREHOSPITAL EMERGENCY CARE

NEAREST UPPER EXTREMITY TO RESCUER

EMITY

closer h your her on on to tinuity ck for g and o this thigh. your t inding. your w and or if it welling

earest manrm. t condeviaheck if and/or Range

NEAREST UPPER EXTREMITY TO RESCUER 1. Start with the arm closer to you. Hold it with your hand on top the other on the opposite direction to check for bone continuity and deformity, check for tenderness, swelling and possible wounds. Do this for all sides of the thigh. Frequently check your gloves for blood that indicates possible bleeding. 2. Using the palm of your hand, cup the elbow and check if its intact or if it has a deformity, swelling or tenderness. 3. Check the forearm nearest you with the same manner done with the arm. 4. Check for the wrist contour and note any deviation from normal, check if there’s deformity and/or swelling. Check for Range of Motion (ROM). 5. Check the hands for PMS.

PMS

NEAREST UPPER EXTREMITY TO RESCUER

LIFELINE ² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

PREHOSPITAL EMERGENCY CARE

223

FUNDAMENTALS OF EMT PRACTICE

DAY 9

Day 9 FARTHEST UPPER EXTREMITY TO RESCUER 1. start with the arm farther to you. Hold it with your hand on top the other on FARTHEST UPPER EXTREMITY the opposite direction to TO RESCUER check for bone continuity 1. Startand with deformity, the arm farther to you. check for Holdtenderness, it with your hand on top the swelling and other on the opposite direction possible wounds. Do this to check for bone continuity and for all sides of the thigh. deformity, check forcheck tenderness, Frequently your swelling and for possible wounds. Do this gloves blood that indior allcates sidespossible of the thigh. Frequently bleeding. your gloves for blood 2.check Using the palm of that your indicates possible bleeding. hand, cup the elbow and 2. Usingcheck the palm of your hand, if its intact or cup if it the elbow and check if its intact has a deformity, swelling or ifor it has a deformity, swelling or tenderness. 3.tenderness. Check the forearm distal 3. Check forearm with to the you withdistal theto you same the same manner done with the arm. manner done with the 4. Check for the wrist contour and note arm. fromthe normal, 4.any deviation Check for wristcheck con-if there’s deformity and/or swelling. tour and note any deviaCheck forfrom Rangenormal, of Motion (ROM). tion check if 5. Check the hands for PMS. there’s deformity and/or swelling. Check for Range of Motion (ROM) 5. Check the hands for PMS

SECONDARY ASSESSMENT

FARTHEST UPPER EXTREMITY TO RESCUER

“

Ang Range of Motion o ROM ay ang normal na naaabot ng mga bahagi ng ating mga kamay, braso, tuhod o paa. Naaapektuhan ito kung may bali o pamamaga sa mga bahaging ito.

FARTHEST UPPER EXTREMITY TO RESCUER

224

LIFELINE

PREHOSPITAL EMERGENCY CARE

² Limmer (Brady) ³ Pollack, (AAOS) ⁴ NHTSA

Obtain Baseline Vital Signs

A complete set of baseline vi signs taken during the seco dary assessment is essential the assessment of a medi patient. Later assessments PEDIATRIC NOTE the vital signs will he compar against (his abaseline set of vi When gathering history fromto a child. be sure to signs determine trends in t kneel or find another way to patient's condition. If you ha get on the same level with the child. Put questions in an automated blood pressu simple language the child can monitoring device, understand. Note that much use it in of the history with for a child local protoc cordance and all of the information Typically, this getting for an infant will needmeans to be gathered from the parents, manual blood pressure fir guardian, or other adult then using the machine to o caretaker tain repeat vital signs.

Obtain Baseline and Vital Transport Signs Administer Administer Interventions the Patient

Interventions and NEAREST UPPER EXTREMITY A complete set of baseline vital signs taken TO RESCUER Transportforthespecific medi during the secondary assessment is essential chapters, you will learn when to provide treatment 1. Start withIn thelater arm closer to the assessment of a medical patient. Later Patient to you. Hold it with your assessments of the vitalyou signs will he compared conditions. The only treatment have learned about so far that might he a hand on top the other on against (his baseline set of vital signs to In later chapters, you propriate patient is oxygen. the opposite direction to for a responsive determine trends in the patientâ&#x20AC;&#x2122;s condition.

will learn when to provide check for bone continuity If you have an automated blood pressure treatment for specific and deformity, check for monitoring device, use it in accordance with medical conditions. The only tenderness, swelling and local protocol. Typically, this means getting treatment you have learned possible wounds. Do this a manual blood pressure first, then using the about so far that might he for all sides of the thigh. machine to obtain repeat vital signs. appropriate for a responsive Frequently check your gloves The sequence of assessment for an unresponsive medical patient patient is oxygen. differs from t for blood that indicates possible bleeding. sequence of assessment for a responsive medical patient. If the patient were Using the palm of your hand, sponsive, cup the elbow and check ifthe its first step of your secondary assessment would be talking with t intact or patient if it has a deformity, to obtain the history of his present illness and the past medical histo swelling or tenderness. followed by the physical exam and baseline vital medical signs.patient Fordiffers an from unresponsive p Check the forearm nearest The sequence of assessment for an unresponsive the you with tient, the same the mannerprocesssequence of assessment for a responsive medical patient. If the patient were responsive, is reversed. Since you cannot obtain a history from the patie done with the arm. the first step of your secondary assessment would be talking with the patient to obtain will begin with the physical baseline vital signs. After these pro Check foryou the wrist contour the history of his present exam illness andand the past medical history, followed by the physical and note dures, any deviation from exam and baseline vital signs. For an unresponsive patient, the process is reversed. Since you will gather as much of (he patient's history as you can from any b normal, check if thereâ&#x20AC;&#x2122;s you cannot obtain a history from the patient, you will begin with the physical exam members may be present. deformitystanders and/or swelling.or familyand baseline vital who signs. After these procedures, you will gather as much of (he patientâ&#x20AC;&#x2122;s Check for Range of Motion history as you can from any bystanders or family members who may be present. (ROM). Another difference between the secondary assessment for the responsive and for Check the hands for PMS.difference the unresponsive patient nature of the physical exam. For a responsive Another between theis the secondary assessment for thepatient, responsive a you will be able to focus your exam on just the part of the body the patient mentions in for the unresponsive patient nature of cannot the physical For a respons his complaint. Sinceisanthe unresponsive patient tell you whereexam. the problem is. you will need to do assessment the entireon body. patient, you will be able toa rapid focus yourofexam just the part of the body the p

Unresponsive Medical Patient

3. 4.

tient mentions in his complaint. Since an unresponsive patient cannot tell y where the problem is. you will need to do a rapid assessment of the entire bod LIFELINE

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225

Day 9

SECONDARY ASSESSMENT

Perform a Rapid Physical Exam The physical exam of an unresponsive medical patient will he almost the same as the head-to-toe physical exam for a trauma patient You will rapidly assess the patient’s head. neck, chest, abdomen, pelvis, extremities, and posterior. As you assess each area, you will look for signs of injury. Other things to look for in the medical patient include: • neck. Jugular vein distention, medical identification devices • Chest. Presence and equality of breath sounds • Abdomen. Distention, firmness, or rigidity • Pelvis. Incontinence of urine or feces • Extremities. Pulse, motor function, sensation, oxygen saturtion, medical identification devices

Medical ID Devices Medical identification devices can provide important information. One of the most commonly used medical identification devices is the Medic Alert emblem. Over 1 million people wear a medical identification device in the form of a necklace or a wrist or ankle bracelet. One side of the device has a Star of Life emblem. The patient’s medical problem is engraved on the reverse side, along with a telephone number to call for additional information. When doing the physical exam, look for necklaces and bracelets or wallet cards. never assume you know the form of every medical identification device. Check any necklace or bracelet carefully, taking care when moving the patient or any of his extremities. You should alert the emergency department staff when you arrive that the patient is wearing or carrying medical identification and tell them what is on it (diabetes or heart condition, for example). Huwag kalimutan na suriin ang pupil o itim sa mata ng pasyente, lalo na kung ito ay walang malay. Laging isipin na pinaka-importanteng suriin ang mga mata ng pasyente ay kung ang mga ito ay nakapikit.

226

LIFELINE

PREHOSPITAL EMERGENCY CARE

Examination of the Unresponsive Medical Patient 1. RAPID PHYSICAL EXAM.

Perform a rapid assessment of the entire body: • Head • neck • Chest • Abdomen • Pelvis • Extremities • Posterior

2. VITAL SIGNS.

3. PAST MEDICAL HISTORY.

Interview family and bystanders for information about the present illness (OPQRST) and also the SAMPLE history: • Signs and symptoms • Allergies • Medications • Pertinent past history • Last oral intake • Events leading to the illness

4. INTERVENTIONS AND TRAN5PORT.

Contact on-line medical direction as needed. Perform interventions as needed and transport the patient.

Obtain Baseline Vital Signs Assess the patient’s pulse, restraining skin, pupils, and blood pressure and note any abnormalities. Determine the patient’s oxygen saturation if you can. Be sure to record your observations so later vital sign assessments can he compared with these baseline observations. If you have an automated blood pressure monitoring device, use it after you have obtained manual blood pressure or in accordance with local protocol. This will allow you to be confident that the machine reading is correct.

Consider a Request for ALS Personnel In accordance with local protocols, and if advanced life support personnel are available, consider at this time if the additional services paramedics can provide would benefit your patient.

advanced care. Consider if it is worth a delay to stop at such a facility fur the special care that may help stabilize your patient before you continue transporting the patient to the hospital.

If you are serving in a rural area or other area where you do not have the option of requesting advanced life support, and if you are very distant from a hospital, there may be a closer local clinic or other health facility that has an arrangement to provide

If arrangements like these exist where you work as an EMT. you must be familiar with the types of patients this facility can help. The arrangements should he in writing in order to reduce confusion and prevent loss of precious lime with critical patients.

Take a History of the Present Illness and a Past Medical History

Since an unresponsive patient cannot talk, you will have to interview’ bystanders to get as much information as possible. When interviewing bystanders, determine if any are relatives or friends of the patient. They usually have more information to provide about past problems than other bystanders would have. See which of the bystanders saw what happened. When questioning bystanders, you should ask:

• What is the patient’s name? If the patient is obviously a minor, ask if the parent or guardian is present or if he or she has been contacted. • What happened? You may he told that the patient fell off a ladder, appeared to faint, fell to the ground and began seizing, was hit on the head by a (ailing object, or other possible clues. • Did you see anything else? For example, was the patient clutching his chest or head before he fell? • Did the patient complain of anything before this happened? You may learn of chest pain, nausea, concern about odors where he was working, or other clues to the problem.

• Does the patient have any known illnesses or problems? This may provide you with information about heart problems, alcohol abuse, allergies, or other problems that could cause a change in the patient’s condition. • Is the patient taking any medications? Be sure to use the word medications or medicines. If you say “drugs” or some other term, bystanders may not answer you. thinking that you are asking questions as part of a criminal investigation. In rare cases, you may feel that the bystanders arc holding back information because the patient was abusing drugs. Remind them that you are an EMT and you need all the information they can give you so proper care can begin. While gathering the patient’s history, you should also see if there is a “vial of Life” or similar type of sticker on the main outside door, closest window to the main door, or the refrigerator door. If so, patient information and medications can usually be found in the refrigerator. (The vial of Life is not used in some regions.)

CRITICAL CONCEPTS • The secondary assessment of the medical patient takes two forms. depending on whether the patient is responsive or not. • You assess the responsive patient by getting a history of the present illness and a past medical history, then performing a physical exam of affected parts of the body before getting baseline vital signs. • Since unresponsive medical patients cannot communicate, it is appropriate to start the assessment with a rapid physical exam. Baseline vital signs come next, and then you interview bystanders, family, and friends to get any history that can be obtained. • You may not change any field treatment as a result of the information gathered here, but the results of the assessment may be very important lo the emergency department staff.

Kung hindi makausap ang pasyente, unahin na ang physical exam at pagkuha ng vital signs bago mag-interview ng mga kamag-anak o kaibigan.

Administer Interventions and Transport the Patient There is not usually much information gained from the secondary assessment of an unresponsive medical patient that will change treatment in the field. The most important thing to look for is a mechanism of injury or signs that would make you suspect a spine injury. Either of these would mean that you need to immobilize the patient’s spine. Most of the time, the information you gather in your assessment of unresponsive medical patients will be particularly helpful to the staff in the emergency department. Emergency physicians and nurses depend on EMTs to evaluate the scene carefully and lo gather as much useful information as possible that they cannot get in the hospital. LIFELINE

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SECONDARY ASSESSMENT OF TRAUMA PATIENT LEARNING OBJECTIVES • Discuss the reasons for reconsideration co cerning the mechanism of injury. • State the reasons for performing a rapid trauma assessment. • Discuss the reason for performing a focused history and physical exam • Differentiate when the rapid assessment may be altered in order to provide patient care

INTRODUCTION For the trauma patient—especially one whose injuries are serious— time must not be wasted at the scene. This patient needs to get to a hospital as quickly as possible. However, you must spend enough time at the scene to adequately assess the patient and give proper emergency care. How can you strike the right balance between care and speed? The key is focus. Instead of performing a timeconsuming, comprehensive assessment on every patient, the EMT focuses in on what is important for a particular patient. Since the primary assessment is what you do first, it makes sense that the next major step is called the secondary assessment. The secondary assessment has several components: history gathering to determine the symptoms and circumstances of the patient’s current concern (history of the present illness) and the nature of the patient’s health problems in the past (past medical history}, physical examination to find signs of injury and illness, and vital signs, including the use of monitoring devices, to determine the patient’s physiological condition.

SECONDARY ASSESSMENT OF THE TRAUMA PATIENT Immediately following the primary assessment for immediate life threats, you will conduct a secondary assessment, sometimes called a secondary survey. This assessment lakes somewhat different paths for trauma and medical patients. In this chapter we will discuss the secondary assessment of the trauma patient. Remember that trauma means “injury.” Injuries can range from slight to severe, from cut finger to a massive wound. Often you will not be able to see the injury1 or how serious it

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NO SIGNIFICANT MECHANISM OF INJURY AFTER SCENE SIZE-UP AND PRIMARY ASSESSMENT:

SIGNIFICANT MECHANISM OF INJURY AFTER SCENE SIZE-UP AND PRIMARY ASSESSMENT:

1. Determine the chief complaint and elicit information about how the patient was injured (history of the present illness). 2. Perform secondary assessment based on the chief complaint and mechanism of injury. 3. Assess baseline vital signs. 4. Obtain a past medical history.

1. Determine the chief complaint and rapidly elicit information about how the patient was injured (history of the present illness). 2. Continue manual stabilization of the head and neck. 3. Consider requesting advanced life support personnel. 4. Perform rapid trauma assessment. 5. Assess baseline vital signs. 6. Obtain a past medical history.

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Is especially if it is internal. usually, however, you will be able to identify the mechanism of injury (MOl). If the MuI is significant, you w ill do the secondary assessment differently than if the mechanism of injury is not significant. If you can sec that there is an obvious major in-jury or signs of major injury (or injuries), you will use the same expedited approach. Examples of a major injury include serious bleeding or penetrating injury to the neck, chest, or abdomen. Signs of a major injury include altered mental status or lack of a patent airway. Although it is important to consider mechanism OF injury, a better and more accurate way to look at this is to consider mechanism OR injury. This is because not

Trauma Patient with No Significant Mechanism or Injury When the patient has no significant mechanism or injury, the steps of the secondary assessment are appropriately simplified. Instead of examining the patient from head to toe, you focus your assessment on just the areas that are clearly injured or that the patient tells you are painful or that you suspect may be injured because of the mechanism of injury. The assessment will include a history of the present illness, physical exam, a set of baseline vital signs, and a past medical history.

Determine the Chief Complaint By now you should already be familiar with the chief complaint. To review. the chief complaint is what the patient tells you is the matter. For example, one patient may tell you he has cut his finger. Another may complain of pain after twisting his ankle.

just the mechanism of injury must be assessed, but also actual injuries to the patient must he assessed in forming a complete evaluation of the severity or potential severity of the patient’s condition. Since you learned about vital signs in Chapter 12.”vital Signs and Monitoring Devices.” this chapter will focus on how to conduct a secondary assessment for a trauma patient. The procedures for a trauma patient who does not have a significant mechanism or injury are discussed in the following section. The procedures for a patient w ho docs have a significant mechanism or injury will be discussed later in the chapter. Table lists and contrasts the procedures for these two categories of trauma patient.

Conduct a History of the Present Illness Although the phrase history of the present illness (HPI) suggests only problems related to sickness, it is used frequently in health care with the word illness meaning both nontrauma medical problems and injuries from trauma. When gelling the HPI for a trauma patient, gather information on how the injury occurred in addition to relevant details. For example, if the patient was in a motorvehicle collision, find out where the patient was in the vehicle, whether the patient was wearing lap and shoulder bells, and the speeds of the vehicles involved. If the patient was on a bicycle or motorcycle, ask whether the patient was wearing a helmet when the incident occurred. If the patient was stabbed or shot, find out the size and type of knife or type of gun and ammunition (only if it is possible to do so safely). A much more important question in shootings is, “How many shots did you hear?” (This is more important than ammunition and such details, because it tells you whether you need to worry about one hole or lots of potential holes.) In general, what you should try to find out in the history of the present illness trauma patient is: • The nature of the force involved (blunt, like hitting the steering wheel: penetrating, such as from a knife or a saw; crushing, such as something heavy falling on the patient) • The direction and strength of the force • Equipment used to protect the patient • Actions taken to prevent or minimize injury • Areas of pain and injuries resulting from the incident If the patient is unable to provide this information because of an altered mental status, use the procedures described later in this chapter on how to assess a patient with a significant mechanism or injury.

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Perform a Physical Exam Your decision on which areas of a patient’s body to assess will depend partly on what you can see (e.g.. the cut on the patient’s finger) and what the patient tells you (the chief complaint, perhaps “My ankle hurls”). But you will not rely just on these obvious signs and symptoms. You will also pay attention to potential injuries the mechanism of injury causes you to suspect. For example, if the patient with the painful ankle suffered his injury by falling down a flight of steps you should suspect that he may have more than just an ankle injury— including a potential spine injury that would require stabilization and. later, immobilization of the patient’s head and spine. There are three techniques of physical examination that an EMT must master: inspection, palpation, and auscultation. When you inspect, you look for abnormalities in symmetry (e.g.. differing chest expansion on one side as compared to the other), color (e.g., pale, flushed, black-andblue, blisters.), shape (e.g.. swelling, deformity, lacerations, punctures, penetrations), and movement (e.g., strength and equality of hand grip strength, ability to raise an arm). When you palpate, you press on possibly injured or affected areas to determine abnormalities in shape, temperature (e.g.. hot, cool), texture (e.g., smooth, wet, abraded), and sensation (e.g.. tenderness, ability to detect touch). Although auscultation means listening, in the context of emergency care, it usually refers to listening with a stethoscope. You will listen to a patient’s chest for abnormalities such as decreased or absent breath sounds, typically comparing one side of the chest to the other. There are many signs of trauma an EMT may detect on physical exam. Which irregularities you search for will depend on the circumstances of the patient and the situation. This chapter will introduce you to the basics of inspection, palpation, and auscultation in the physical exam. In later chapters on specific injuries and illnesses, you will learn more about how to evaluate specific areas and what to search for. One aid some EMTs use when performing a physical exam is the acronym DCAP-BTLS, which stands for deformities, contusions, abrasions, punctures and penetrations, burns, tenderness, lacerations, and swelling. Although this memory aid may be helpful, it does not include all of the abnormalities an EMT may encounter and so must be used with caution, if at all. Deformities are just what they sound like, parts of the body that no longer have the normal shape. Common examples arc broken or fractured bones that push up the skin over the bone ends. Contusions is the medical term for bruises. Abrasions, or scrapes, are some of the most common injuries you will sec. Punctures and penetrations are holes in the body, frequently the result of gunshot wounds and stab wounds. When they arc small, they are 230

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easy to overlook. Burns may he reddened, blistered, or charred-looking areas. Tenderness means that an area hurts when pressure is applied to it. as when it is palpated. Pain (which is present even without any pressure) and tenderness frequently, but not always, go together. Lacerations are cuts, open wounds that sometimes cause significant blood loss. Swelling is a very common result of injured capillaries bleeding under the skin. Wounds, tenderness, and deformities is a classification that is simpler to remember than DCAP-BTLS but that covers a similar range of signs and symptoms you should watch for in the patient with trauma or suspected trauma. Wounds, tenderness, and deformities are the categories that will be summarized later and that will referred to throughout the physical examination portions of this chapter. In order to find these signs and symptoms, you will need to expose the patient. This means removing or cutting away clothing so you can see and palpate the area or areas of the body you are assessing. Compare normal to injured areas to determine if an abnormality exists. Be sure to tell the patient what you are doing and offer reassurance as necessary. Protect the patient’s privacy, and take steps to prevent unnecessarily long exposure to cold.

Obtain Baseline Vital Signs and a Past Medical History For a trauma patient, first conduct a history of the present illness and a physical exam to assess his injuries. next, assess his baseline vital signs and lake a past medical history. An EMT can gain two kinds of information about the patient’s problem: signs and symptoms. A sign is objective—something you see. hear. feel, and smell when examining the patient. The vital signs are. of course, signs, as arc sweaty skin, staggering, and vomiting. for example. A symptom is subjective—an indication you cannot observe but that the patient feels and tells you about. Such things as chest pain, dizziness, and nausea are considered symptoms. An important part of the information you should gain on all of your patients is information about the past medical history . The past medical history is often referred to in EMS as the SAMPLE history because the letters in SAMPLE stand for elements of the history: signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading to the injury or illness. To obtain the past medical history, ask your patient (or. if the patient is unconscious, ask the family and bystanders) these questions: • Signs and symptoms. What’s wrong? This is a reminder to get the history of the present illness. • Allergies. Are you allergic to medications, foods or do you have environmental allergies? Is there a medical identification tag describing your allergies? • Medications. What medications arc you currently

taking or are you supposed to be taking (prescription, over-the-counter, or recreational)? Are you on birth control pills? Is there a medical identification lag with the names of medications on it? Do you take any herbal supplements or medications? • Pertinent past history. Have you been having any medical problems? Have you been feeling ill? Have you recently had any surgery or injuries? Have you been seeing a doctor? What is your doctor’s name? • Last oral intake. When did you last cat or drink? What did you eat or drink? (Food or liquids can cause symptoms or aggravate a medical condition. Also, if a patient will need to go to surgery, the hospital staff must know when he last had anything to eat or drink, since stomach contents can be vomited while a patient is under anesthesia, which is a very dangerous occurrence.) • Events leading to the injury or illness. What sequence of events led up to today s problem (e.g., the patient passed out. then got into a car crash versus got into a car crash and then passed out)?

Applying a Cervical Collar Apply a cervical collar to any patient who may have an injury to the spine based on mechanism of injury, history, or signs and symptoms (Remember that signs are what you observe: symptoms are what the patient tells you he feels.) When is it appropriate to apply a cervical collar? There is a simple principle you can follow; If the mechanism of injury exerts significant force on the upper body or if there is any soft-tissue damage to the head. face, or neck from trauma (such as a cut or bruise from being thrown against a dashboard), you may then assume that there is a possible cervical-spine injury- Any blow above the clavicles (collarbones) may damage the cervical spine, as may a fall from a height, even if the patient landed on his feet. Some patients cannot communicate because of a depressed level of responsiveness, intoxication with alcohol or other drugs, or an inability to speak your language. Similarly, a painful injury in an area other than the neck may limit the patient’s ability to sense neck pain and communicate that to you. In cases like these, if injury cannot be ruled out—even if the mechanism of injury is not known—suspect cervical-spine injury. When any of these conditions exist, apply a cervical collar. It should also be noted that patients with penetrating trauma such as gunshot wounds do not require placement of a cervical collar unless there are signs or symptoms of neurological injury or if the patient is unconscious and cannot he fully assessed for these findings. Several types of cervical-spine immobilization devices arc on the market. It is important that you select one that is rigid (stiff, not easily movable) and that is the right

size. The traditional soft collar that you occasionally sec someone wearing on the street has no role in immobilizing a prehospital patient’s cervical spine. The wrong size immobilization device may actually harm the patient by making breathing more difficult or obstructing the airway. Whatever device is used must not obstruct the airway. If the proper size collar is not available, it is better to place a rolled towel around the neck (to remind the patient not to move his head) and tape the patient’s head to the backboard. The techniques (or selecting the right size cervical collar and for applying a cervical collar are presented in this topic. As you study the scan and practice applying a cervical collar, consider the following: • Make certain that you have completed the primary assessment and that you have cared for all lifethreatening problems before you apply the collar. • use the mechanism of injury, level of responsiveness, and location of injuries to determine the need for cervical immobilization. Apply a rigid cervical collar whenever any of these factors leads you to believe that spine injury is a possibility • Assess the patients neck prior to placing the collar. Once the collar is in place, you will not be able to inspect or palpate the back of the neck. • Reassure the patient. Having a cervical collar applied around your neck can be a constricting and frightening experience. Explain the procedure to the patient. • Make sure the collar is the right size for the patient. The proper size rigid collar depends more on the length or the patient’s neck than on the width. A large patient may not be able to wear a large collar. A small patient with a long neck may need your largest collar. The rum i height of the collar should fit between the point of the chin and the chest at the suprasternal (jugular) notch— the u-shaped dip where ihe clavicle and sternum meet. Once in place, the collar should rest on the clavicles and support the lower jaw. It should not stretch the neck (too high), it should not support the chin (too short), and it should not constrict the neek (loo tight). • Remove the patient’s necklaces and large earrings before applying the collar. • Keep the patient’s hair out of the way. • Keep the patient’s head in the in-line anatomical position (a neutral position with head facing front, not tilted forward or back or turned to either side) when applying manual stabilization and the collar. Cervical collars alone do not provide adequate in-line immobilization. In fact applying the collar is not the first step. Whenever there is the possibility of a spine injury, you must manually stabilize the patient’s head and neck immediately upon first patient contact, be-fore applying the collar. Continue to manually stabilize the head and neck, both before and after applying the cervical collar, until the patient is completely immobilized and secured to a backboard.

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Trauma Patient with a Significant Mechanism or Injury When you have a patient you have determined is unstable or potentially unstable because of problems found in the primary assessment or because of a significant mechanism or injury, you will do all of the following: continue manual stabilization of the head and neck, consider requesting advanced life support (ALS) personnel, and perform a rapid trauma assessment. Some patients who undergo experiences like those listed will escape without serious injury, but many more will not be so lucky. For this reason, you should provide rapid assessment and treatment to any patient with a mechanism of injury. Although the mechanism of injury can provide a lot of information about the kinds of injuries a patient may have, there is still the possibility that patients will have “hidden injuries.” These injuries are considered to be hidden because patients may have no signs or symptoms initially but nevertheless have serious conditions that may become apparent only later.

ASSESSING A TRAUMA PATIENT Ang mga pasyente na may malinaw na injury ay nangangailangan ng mabilisang pagtugon. Pero kailangan din nila ng mas malalim na pagsusuri dahil posibleng meron pa silang injury na hindi agad nakita ng EMT. Kaya mahalaga na suriin sila mula ulo hanggang paa habang nilalapatan ng karampatang lunas ang injury na agad na nakita.

PEDIATRIC NOTE Infants and children are more fragile than adults. This means that a child may sustain the same injury as an adult, but from less force. For this reason, there are additional mechanisms of injury that the EMT needs to consider when children and infants are concerned

Field Triage: Significant Mechanisms of Injury GUIDELINES FOR FIELD TRIAGE OF INJURED PATIENTS Transport to a trauma center if any of the following are identified: • Falls • Adults: fall >20 feet (one story - 10 feet) • Children aged <15 years: fall >10 feet or two to three times child’s height • High-risk auto crash • Intrusion: >12 inches to the occupant site or <18 inches to any site • Ejection (partial or complete) from automobile

• Death in same passenger compartment • vehicle telemetry data consistent with high risk of injury • Auto versus pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact; or • Motorcycle crash >20mph.

Physical Examination of the Trauma Patient Reassess the mechanism of injury and actual injury. If the mechanism or injury is not significant (e.g., patient has a cut finger), focus the physical exam only on the injured part. If the mechanism or injury is significant: • Continue manual stabilization of the head and neck. • Reassess mental status • Perform a rapid trauma assessment • Consider requesting ALS personnel. • Reconsider transport decision. 232

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Source Centers for Disease Control and Prevention. Guidelines for Field Triage of Injured Patients. Recommendation of the National Expert Panel on Field Triage, Morbidity and Mortality Weekly. Report, (MMWR) January 23, 2009. Vol. 58, No. RR-1.

HISTORY OF THE PRESENT ILLNESS Rapidly determine what happened to the patient to cause injury.

RAPID TRAUMA ASSESSMENT

VITAL SIGNS

Assess the patient’s baseline vital signs: • Respiration • Pulse • Skin color, temperature, condition (capillary refill in infants and children) • Pupils • Blood pressure • Oxygen saturation (if directed by local protocol)

PAST MEDICAL HISTORY Interview patient or (if

Rapidly assess each part of the body. • HEAD: Check for WOunDS. patient is unresponsive) family TEnDERnESS, AnD DEFORMITIES plus and bystanders to get as much crepitation. information as possible about • FACE: Check for WOunDS, TEnDERnESS, the patient’s problem. Ask about: AnD DEFORMITIES. • Signs and symptoms • EARS: Check for WOunDS, TEnDERnESS, • Allergies AnD DEFORMITIES plus drainage of blood • Medications or clear fluid. UNIT UNIT22 • Pertinent past history • EYES: Check for WOunDS, TEnDERnESS, DAY DAY99 • Last oral intake AnD DEFORMITIES plus discoloration, • Events leading to problem unequal pupils, foreign bodies, and blood in the anterior chamber. • nOSE: Check for WOunDS, TEnDERnESS, AnD DEFORMITIES plus INTERVENTIONS INTERVENTIONSAND ANDTRANSPORT TRANSPORT drainage of blood or clear fluid. • MOuTH: Check for WOunDS, TEnDERnESS, AnD DEFORMITIES plus loose or broken teeth, objects that could cause obstruction, swelling or laceration of the tongue, unusual breath odor, or discoloration. • nECK: Check for WOunDS, TEnDERnESS, AnD DEFORMITIES plus jugular vein distention and crepitation, • APPLICATIOn OF COLLAR: Once the neck has been examined, apply the cervical collar. • CHEST: Inspect and palpate for WOunDS, TEnDERnESS, AnD DEFORMITIES plus crepitation and paradoxical motion. Contact Contact on-line on-line medical medical direction direction and and perform perform interventions interventions asas needed. needed. Package Package Contact on-line medical direction and perform interventions • CHEST: Auscultate for BREATH SOunDS and and transport transport the the patient. patient. as needed. Package and transport the patient. (presence, absence, and equality). • ABDOMEn: Check for WOunDS, Seat Seat bell bell injuries injuries areare aa good good example. example. There There is is nono doubt doubt that, that, when when properly properly Seatsave belt injuries are a good example. There is no doubt that, TEnDERnESS, AnD DEFORMITIES plus used, used, seat seat belts belts save lives lives byby preventing preventing drivers drivers and and passengers passengers from from hitting hitting hard hard when properly used, seat belts save lives by preventing drivers firm, soft, and distended areas. objects objectsinside inside a avehicle vehicle and and byby preventing preventing them them from frombeing being ejected. ejected.BuiBuiscat scat and passengers from hitting hard objects inside ahigh-velocity vehicle andcollisions, • PELvIS: Check for WOunDS, belts belts can can also also cause cause injuries. injuries. When When patients patients are are in in high-velocity collisions, the the by preventing them fromagainst being ejected. Bui seat belts can also TEnDERnESS, AnD DEFORMITIES using force force of of being being thrown thrown forward forward against buckled buckled seat seat belt!belt!will will occasionally occasionally cause cause injuries. When patients are in high-velocity collisions, the gentle compression for tenderness or motion. injury injury tocause to the the bowel bowel and and other other abdominal abdominal organs. organs. Similarly, Similarly, patients patients with with scat scat bell bell force of being thrown forward against buckled seat belt will • uPPER ExTREMITIES: Check for marks marks onon the the upper upper chest chest and and side side of of the the neck neck may may sustain sustain trauma trauma toto the the major major occasionally cause injury tothe the bowel andinjuries other abdominal WOunDS, TEnDERnESS, AnD arteries arteries in in the the neck neck that that supply supply the brain. brain. These These injuries may may not not become become apparapparorgans. Similarly, patients withIt seat belt markstoon the upper chest DEFORMITIES. ent ent forfor several several hours hours oror even even days. days. It is is important important to realize realize that that even even people people andwearing side of the neck may sustain trauma to serious the major arteries in • uPPER ExTREMITIES: Check for who who were were wearing seat seat belt* belt* may may have have sustained sustained serious injuries. injuries. the neck that supply the brain. These injuries may not become CIRCuLATIOn, SEnSATIOn, AnD apparent for several hours or even days. It is important to realize MOTOR FunCTIOn. AirAir bags bags may may also also save save lives: lives: however, however, they they dodo not not provide provide total total protection protection from from that evenprevent people who were wearing seat belt* may have sustained • LOWER ExTREMITIES: Check for injury. injury. Air Air bags bags prevent occupants occupants from from going going through through the the windshield windshield and and hit-hitserious injuries. ting ting hard hard objects objects inside inside the the vehicle. vehicle. However, However, they they only only protect protect occupants occupants once, once, WOunDS. TEnDERnESS, AnD even even if the if the vehicle vehicle sustains sustains collisions collisions with with several several other other vehicles vehicles oror objects objects They They DEFORMITIES. Air bags mayused also save lives: however, they dobelts. not provide areare most most effective effective when when used in in combination combination with with seat seat belts. In In a few a few instances, instances, • LOWER ExTREMITIES: Check for total protection from injury. Air bags prevent occupants from especially especially with with a small a small driver driver or or passenger passenger (particularly (particularly a child) a child) or or when when [he [he front front CIRCuLATIOn, SEnSATIOn, AnD going through the or windshield hitting hard inside thethethe seal seal is is pulled pulled far far forward, forward, or when when a seat aand seat belt belt is is not not inobjects in place place to to keep keep person person MOTOR FunCTIOn. vehicle. However, they only protect occupants once, eveninjury. ifinjury. the from from being being thrown thrown forward, forward, the the expanding expanding airair bag bag may may cause cause “ “ Check for WOunDS, • POSTERIOR: vehicle sustains collisions with several other vehicles or objects TEnDERnESS, AnD DEFORMITIES. (To Also, Also, the the driver driver may sustain sustain anwhen an arm arm injury injury because of of improper improper positioning of of They aremay most effective used in because combination with seat positioning examine posterior, roll patient using spinal hands hands onon the the steering steering wheel wheel oror may may sustain sustain I chest I chest injury injury from from hitting hitting the the steersteerprecautions.)

FUNDAMENTALS FUNDAMENTALSOF OFEMT EMTPRACTICE PRACTICE

INTERVENTIONS AND TRANSPORT

inging wheel wheel after after the the bag bag deflates. deflates. When When inspecting inspecting a vehicle a vehicle in in which which anan airair bag bag has has deployed, deployed, you you should should look look at at the the steering steering wheel. wheel. Whenever Whenever you you see see a bent a bent oror broken broken steering steering wheel, wheel, you you should should treat treat the the patient patient like like every every other other patient patient LIFELINE PREHOSPITAL EMERGENCY CARE 233 who who has has a significant a significant mechanism mechanism of of injury. injury. AA good good way way toto find find this this kind kind of of damdamage age is to is to remember remember toto "lift"lift and and look" look" under under the the airair bag bag after after the the patient patient has has been been removed removed from from the the vehicle. vehicle. Using Using mechanism mechanism of of injury injury asas a tool a tool forfor determining determining your your assessment assessment has has signifisignifi-

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belts. In a few instances, especially with a small driver or passenger (particularly a child) or when the front seat is pulled far forward, or when a seat belt is not in place to keep the person from being thrown forward, the expanding air bag may cause injury. Also, the driver may sustain an arm injury because of improper positioning of hands on the steering wheel or may sustain I chest injury from hitting the steering wheel after the bag deflates. When inspecting a vehicle in which an air bag has deployed, you should look at the steering wheel. Whenever you see a bent or broken steering wheel, you should treat the patient like every other patient who has a significant mechanism of injury. A good way to find this kind of damage is to remember to “lift and look” under the airbag after the patient has been removed from the vehicle. using mechanism of injury as a tool for determining your assessment has significant limitations. Study in this area is still needed to indicate more clearly which patients will benefit from expedited assessment, treatment, and transport. Determining whether a patient has a significant MOI when he has an obviously critical injury- wilt not make a difference in your decision making Although you will note the MOI for potential use by hospital staff, you will do a rapid trauma assessment for the patient with a significant injury whether or not he has a significant MOI.

Continue Spinal Stabilization During the primary assessment, make sure that someone is manually stabilizing the patient’s head to prevent any cervical-spine injury from becoming a paralyzing spinal-cord injury. Manual stabilization must continue throughout the assessment until the patient is fully immobilized on a backboard.

Consider a Request for Advanced Life Support Personnel Some areas of the country, particularly urban and suburban areas, have advanced life sup-port (ALS) personnel—paramedics who respond with EMTs when they are transporting patients who might benefit from the additional interventions paramedics can provide. If this is the case where you practice as an EMT you should familiarize yourself with your local protocols. Rural EMTs do not always have this option, but they may have other means by which to improve the patient’s care before arrival at a hospital.

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Ang airbag sa kotse ay nakakatulong para hindi lumusot sa windishield o tumama sa manibela ang biktima sa oras ng aksidente. Pero posible rin itong maging sanhi ng injury. Kung may makita kang air bag na nagdeploy, huwag kalimutan na suriin ang pasyente sa posibleng injury na dulot nito. In some areas that are very distant from hospitals, local clinics arrange to provide advanced care to certain kinds of patients. For example, if an ambulance is an hour away from the closest hospital, but a local clinic is only 10 minutes away, the ambulance may be able to stop there with a patient in cardiac arrest. There are limits, though, on what can be done at health care centers like these. Many of them would not be able to provide additional care that is worth a delay in transport (or awake trauma patients.

Significant Injuries and Signs of Significant Injuries • unresponsive or altered mental status • Penetrating wound of the head, neck, chest, or abdomen (e.g., stab and gunshot wounds) • Airway that is not patent • Respiratory compromise • Pallor, tachycardia, and other signs of shock lf arrangements like these exist where you work as an EMI’, you must be familiar with the types of patients your clinic can help. The arrangements should be in writing in order to reduce confusion and prevent loss of precious lime with critical patients. In any case, the patient with serious trauma must ultimately, if at all possible, be transported to a trauma center.

Perform a Rapid Trauma Assessment A patient with a significant mechanism or injury needs a quickly performed physical exam, known as the rapid trauma assessment. This requires only a few moments and should be performed at the scene, before loading the patient into the ambulance, even if the patient is a high priority for transport. The care that you provide en route will be based on the results of this rapid assessment, and you will obtain valuable information to relay to the hospital staff so that they can be prepared for your patient. During the rapid trauma assessment, you will be able to detect injuries that may later threaten life or limb. You may also find life-threatening injuries that you did not

find during the primary assessment. When dealing with a responsive patient, you should ask the patient before and during the trauma assessment about any symptoms. To perform the rapid trauma assessment, you will use your sense of sight to inspect and your sense of touch to palpate different areas of the body. You may also use your sense of hearing to detect abnormal sounds, not just from the airway but also from other areas, such as the sound of broken hones rubbing against each other. You may use your sense of smell, at well, to detect odors like gasoline, urine, feces, or vomit. You will evaluate the patient from head to toe. in the sequence described next. The signs and symptoms you will assess in each area must be summarized. Remember, however, that this is a quick evaluation, so you will not spend a lot of time on any one area. RAPID ASSESSMENT OF THE HEAD. Gently palpate the cranium for wounds, tenderness, and deformities, as well as the sound or feel of broken bones rubbing against each other, known as crepitation. Run your

gloved fingers through the patient’s hair and palpate gently. A good way to check the back of the head in a supine patient is to start with your fingers at the top of the neck and carefully slide them upward toward the top of the patient’s head. If there is blood on your gloves, there is an open wound. However, if you do not see any blood on the floor or ground, then you do not need to apply a dressing to the wound right away. Inspect and palpate the face for wounds, tenderness and deformities by looking and then gently palpating the cheekbones, forehead, and lower jaw. The bones in the face are fragile and may break when subjected to significant forces. Inspect and palpate the ears, searching for wounds, tenderness, and deformities, as well as drainage of blood or other fluid. If these are found, they are important pieces of information to pass on to the emergency department staff because they may be indications of injury to the skull. Also gently bend each ear forward to look for any bruising. A bruise behind the patient’s ear is called Battle’s Sign and is another important sign of skull injury to tell hospital staff about.

Physical Exam/Trauma Assessment BODY PART

WOUNDS, TENDERNESS, AND DEFORMITIES

PLUS

Head

Wounds, tenderness, and deformities

Crepitation

Neck

Wounds, tenderness, and deformities

Jugular vein distention, crepitation

Chest

Wounds, tenderness, and deformities

Paradoxical motion, crepitation, breath sounds (present,absent,equal)

Abdomen

Wounds, tenderness, and deformities

Firmness, softness, distention

Pelvis

Wounds, tenderness, and deformities

Firmness, softness, distention

Extremeties

Wounds, tenderness, and deformities

Pain, tenderness, motion

Posterior

Wounds, tenderness, and deformities

Distal circulation, sensation, motor function

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Applying a Cervical Collar SIZING A CERVICAL COLLAR 1. Measure the patient’s neck. 2. Measure the collar. The chin piece should not lift the patient’s chin and hyperextend the neck. Make sure the collar is not too small or light, which would make the collar act as a constricting band.

APPLYING AN ADJUSTABLE COLLAR TO A SEATED PATIENT

APPLYING AN ADJUSTABLE COLLAR TO A SUPINE PATIENT

1. Stabilize the head and neck from the rear. 2. Properly angle the collar for placement 3. Position the collar 4. Begin to secure the collar 5. Complete securing the collar 6. Maintain manual stabilization of the head and neck.

1. Kneel at the patient’s head and stabilize the head and neck 2. Set the collar in place 3. Secure the collar 4. Continue to manually stabilize the head and neck

next assess the eyes, inspectingfor the usual wounds. tenderness. and deformities, as well as discoloration, unequal pupils, foreign bodies, and mood in the anterior chamber (front) of the eye. Blood in the anterior chamber is not common: however, when present, it is a sign that the eye sustained significant force and is bleeding inside. Inspect and palpate the nose for injuries or signs of injury. Look not only for wounds, tenderness, and deformities but also for drainage and bleeding. When assessing the ears and nose, you may find blood or clear fluid draining from them. Blood may be from a laceration of that area or it may be coming from inside the skull. Clear fluid may be just from a runny nose or it may be cerebrospinal fluid (CSF). You should prevent an ear or nose that is draining blood or clear fluid from getting any dirtier than it is at that point. CSF surrounds the brain and spinal cord, and if it is leaking out then bacteria can get into the brain. Similarly, a wound from inside the skull that is leaking blood can also provide a route for bacteria to get in. Open the patient’s mouth and look for wounds, tenderness, and deformities. Look for broken teeth, other objects that could cause obstruction, swelling or laceration of the tongue, unusual breath odor, and discoloration. A foreign body like a broken tooth is a potential source of airway obstruction and must be removed as soon as possible from the patient’s mouth. The most common odor is from alcoholic beverages. Other condions besides alcohol, though can cause similar odors. RAPID ASSESSMENT OF THE NECK. Assess the neck for wounds, tenderness, deformities, and jugular vein distention (JvD). Jugular vein distention is present when you can see the patient’s neck veins bulging. The neck veins are usually not visible when the patient is sitting up. If they are bulging when the patient is upright, it means that blood is backing up in the veins because the heart is not pumping effectively. This could be the result of a tension pneumothorax (air trapped in the chest) or cardiac tamponade (blood filling the sac around the heart). However, it is normal to see bulging of the neck veins when the patient is lying in a horizontal 236

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position or with his head down. Flat neck veins in a patient who is lying down may be a sign of blood loss, showing that there is not enough blood to fill them. When you see flat neck veins in a patient, think “blood loss.” To summarise, either neck veins that are bulging when the patient is silting up or neck veins that are flat when the patient is flat are abnormal and should be noted during the exam. Another thing you might find when assessing the patient’s anterior neck is a surgical opening. A stoma is a permanent surgical opening in the neck through which the patient breathes. A tracheostomy is a surgical incision held open by a metal or plastic lube. If the patient requires artificial ventilation, you may need to provide it through the stoma. You may also find a medical identification medallion on a necklace when assessing the neck. note the information on the necklace if you find one. After you assess the patient s head and neck, size and apply a rigid cervical spine immobilization collar. use the principles and methods that were described earlier. RAPID ASSESSMENT OF THE CHEST. next, assess the chest for wounds, tenderness, deformities, crepitation, breath sounds, and paradoxical motion. Paradoxical motion, or movement of part of the chest in the opposite direction from the rest of the chest, is a sign of a serious injury. It usually occurs when several ribs have broken at two ends and are “floating” free of the rest of the rib cage. (This condition is sometimes known as “flail chest.”) The opposite motion of the broken section is obvious during respiration, moving inward when the lungs expand with air and outward when the lungs empty. Paradoxical motion also indicates that a great deal of force was applied to the patient’s chest: in other words, there was a significant mechanism of injury. You can check for crepitation and paradoxical motion of the chest at the same time. Start by palpating the patient’s clavicles (collarbones). next, gently feel the sternum (breastbone). Position your hands on the sides of the chest and feel for equal expansion of both sides of

the chest. During this process you may feel broken bones or floating paradoxical segments. Palpate the entire rib cage for deformities. use your hands to apply gentle pressure to the sides of the rib cage. If there is an injured rib and the patient is able to respond, he will tell you that it hurts. Occasionally, you may detect a crackling or crunching sensation under the skin from air that has escaped from its normal passageways. This is called subcutaneous emphysema. Listen for breath sounds just under the clavicles in the mid-clavicular line and at the bases of the lungs in the midaxillary line. notice whether the breath sounds are present and equal. A patient who has breath sounds that are absent or very hard to hear on one side may have a collapsed lung or other serious respiratory injury. There are many other characteristics of breath sounds, but in the trauma patient, presence and equality are the two things lo look for at this time. It is important to remember that when you reach the point of examining the patient’s chest in the rapid trauma assessment, you need to expose the chest if you have not already done so. However, keep the weather and the patient’s privacy in mind when doing this. RAPID ASSESSMENT OF THE ABDOMEN. When you assess the abdomen for wounds, tenderness, and deformities, also check for firmness, softness. and distention. The term distention is another way of saying the abdomen appears larger than normal. One of its causes can be internal bleeding. Whether the abdomen is abnormally distended or not may be a very difficult judgment to make, so do not spend a lot of time on it. You may also see a colostomy or ileostomy when you inspect the abdomen. This is a surgical opening in the abdominal wall with a bag in place to collect excretions from the digestive system. If you see such a bag, leave it in place and be careful not to cut it if you cut clothing away. Palpate the abdomen by gently pressing down once on each abdominal quadrant. Picture the abdomen divided into four segments—upper left, upper right, lower left, lower right—and press on each quadrant in turn.) If the patient tells you he has pain in a specific area of the abdomen, palpate that site last. When practical, make sure your hands are warm. Press in on the abdomen with the palm side of your fingers, depressing the surface about 1 inch. Many EMTs prefer to use two hands, one on top of the other at the fingertips. normally, the abdomen is soft. Firmness of the abdomen can be a sign of injury to the organs in the abdomen and internal bleeding. Another finding you may occasionally come across when palpating a patient’s abdomen is a pulsating mass. This may be an enlarged aorta. If you do feel such pulsations, do not press any farther into the abdomen. Doing so could cause further injury to a weakened blood vessel. RAPID ASSESSMENT OF THE PELVIS. next, assess the pelvis for wounds, tenderness, and deformities. You may observe bleeding or priapism, a persistent erection of the penis that can result from spinal cord injury or certain medical problems. If

the patient is awake, palpate the pelvis gently, stopping as soon as the patient identifies pain in the pelvis. Consider the complaint of pain as reason enough to treat the patient for an injury to the pelvis. Continuing to palpate or compress the painful pelvis of a conscious patient will not give you any more useful information, but it can produce excruciating pain and. if done too strenuously, may injure the patient. RAPID ASSESSMENT OF THE POSTERIOR BODY AND IMMOBILIZATION ON A BACKBOARD. Roll the patient onto his side as a unit and assess the posterior body, inspecting and palpating for wounds, tenderness, and deformities in the area of the spine and to the sides of the spine, the buttocks, and the posterior extremities. Meanwhile, have someone slide a back hoard next to the patient so that, when you roll the patient back into a supine position, he is on the backboard. If the patient has shown signs or symptoms of an injury to the pelvis, local protocol may direct you to place a pneumatic anti-shock garment (PASG) on the board before you roll the patient onto it. Local protocol may direct you to place the anti-shock garment on the backboard for other kinds of trauma, too. A newer method of stabilizing an injured pelvis is forming a pelvic wrap from a folded sheet. Become familiar with how local medical direction wishes you to manage these patients. OBTAIN BASELINE VITAL SIGNS AND PAST MEDICAL HISTORY. Quickly obtain a set of baseline vital signs. If using a pulse oximeter is part of your assessment, apply it now (or earlier, if your local protocol suggests doing so). If the patient is unresponsive, you will not be able to get a past medical history from him. If there is a friend or family member nearby, that person may be able to give you information about the patient’s medical history. An unconscious patient, however, cannot tell you if his pelvic area hurts. Therefore, you will gently compress the pelvis of the unconscious patient to detect tenderness (if there is enough responsiveness to pain to cause him to flinch or groan) and motion of the bones (indicating instability or broken bones). These signs will help you determine whether you need to treat the unconscious patient for a pelvic injury. RAPID ASSESSMENT OF THE EXTREMITIES. Quickly assess all four extremities for wounds, tenderness, and deformities, as well as distal circulation, sensation, and motor function—that is, whether a pulse is present, the patient has feeling in his hands and feet, and he can move his hands and feel. In a conscious patient, you will touch the patient’s hand or foot and ask whether he can feel your touch. If you are not sure whether the patient is telling you the truth, you can ask where on the hand or foot you are touching him. You can also test movement in the extremists of a conscious patient by asking him to squeeze your fingers in his hands and to move his feel against your hands. If you find a deformity, diminished function, or other indication of injury to an extremity in a patient who is a high priority for transport, you will not splint the extremity at the scene but will treat it en route. LIFELINE

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Assessing Distal Function Assess all four extremities for distal circulation, sensation, and motor function. Diminished function may be a sign of injury that has compromised circulation, motor function, of nerve function. Distal function should be checked both before and after any interventions such as splinting, bandaging, and immobilization, and at intervals during transport, to be sure such interventions are not interfering with distal function. IF distal function has become compromised, adjust your interventions as necessary. 1. Assess distal circulation in the upper extremities by feeling for radial pulses. 2. Assess distal motor function by checking the patient’s ability to move both hands. 3. Assess strength in the hands by asking the patient to squeeze your fingers. 4. Assess distal sensation to the upper extremities by asking the patient, “Which finger am I touching?” (Be sure the patient cannot see which finger.) If the patient is unresponsive, check distal sensation in the upper extremities by pinching the back of the hand. Watch and listen for a response. 5. Check distal circulation in the lower extremities by feeling the posterior tibial pulse just behind the medial malleolus of the ankle, or feel the dorsalis pedis pulse al the top of the foot. 6. Assess distal motor function by checking the patient’s ability to move his feet. 7. Assess strength in the feel and legs by asking the patient to push against your hands. 8. Assess distal sensation in the lower extremities by asking the patient, “Which toe am I touching?” (Be sure the patient cannot see which toe.) If the patient is unresponsive, check distal sensation in the lower extremities by pinching the top of the foot, Watch and listen for a response.

Some General Principles Several important principles to remember when examining a patient, which are mentioned throughout the chapter, arc summarized in the following list: • Tell the patient what you are going to do. In particular, let the patient know when there may be pain or discomfort. Stress the importance of the examination and work to build the patient’s confidence. Ask the patient if he understands what you are doing, and explain your actions again if needed. • Expose any injured area before examining it. By exposing areas, you can see such things as bruises and puncture wounds. Let the patient know when you must lift, rearrange, or remove any article of clothing. Do all you can to ensure the patient’s privacy. • Try to maintain eye contact. Do not turn away while you are talking or while the patient is answering your questions. • Assume spinal injury. unless you are sure that you are dealing with a patient who does not have a spine injury (e.g.. a medical patient with no mechanism or injury or reason lo suspect trauma), assume the patient has such injuries. Always assume that the unconscious trauma patient has a spine injury. Manually stabilize the head and neck on first contact with the patient, fit the patient with a properly sized cervical collar as soon as you have examined the head and neck, and fully immobilize the patient to a spine board before transport to the hospital. • During the physical exam, you may stop or alter the assessment process to provide care that is necessary and appropriate for the priority of the patient. For a patient who is not a priority for rapid transport, you may pause to bandage a bleeding wound, even if the bleeding is not life threatening, or to splint an injured extremity. • During the rapid trauma assessment, apply a cervical collar if spine injury is suspected. For a patient who is a priority for rapid transport, treatments such as controlling non-life-threatening bleeding or splinting an injured extremity may take place en route to the hospital if time and the patient’s condition permit.

PEDIATRIC NOTE The secondary assessment of the pediatric (infant or child) trauma patient is very similar to the secondary assessment of the adult patient. One important difference is that you may need to spend more time reassuring children and explaining procedures to them. You will want to kneel or find another way to get on the same level with the child as you speak with him. Young children may be frightened if you begin your assessment at the toes and work toward the head instead of proceeding in the usual head-to-toe direction. A child’s airway is narrower than an adult’s and more susceptible to being closed. A cervical collar that is too tight can easily constrict a child’s airway, and a collar that is too high can close the airway by stretching the neck Therefore, it is especially important to choose the correct size cervical collar for a child

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DETAILED PHYSICAL EXAM The primary assessment and the rapid trauma assessment are done quickly because of the necessity or getting the seriously injured or ill patient into the ambulance and to the hospital without delay, En route to the hospital, you may have time to do a more complete patient assessment known as the detailed physical exam. If you are not on a transporting unit and the ambulance has not arrived, you may do the detailed physical exam at the scene. The purpose of the detailed physical exam is to gather additional information about the patient’s injuries and conditions. Some of this information may help you to determine the proper treatment for the patient, and some of the information you gather in the detailed physical exam will assist the emergency department staff. The detailed physical exam is performed most often on the trauma patient with a significant injury or mechanism of injury, less often on a trauma patient with no significant injury or mechanism of injury, and seldom on a medical patient.

Trauma Patient with a Significant Injury or Mechanism of Injury For a trauma patient who is not responsive or has a significant injurs1 or an unknown mechanism of injury, you will have assessed almost the entire body during the rapid trauma assessment—but very quickly. For this patient, a detailed physical exam may reveal signs or symptoms of injury that you missed or that have changed since the rapid trauma assessment

Before Beginning the Detailed Physical Exam It is important to remember that you should perform the detailed physical exam only after you have performed all critical interventions. The best way to ensure this is to repeat your primary assessment before you begin the detailed physical exam. To do this, reassess your general impression of the patient, focusing on his mental status, plus airway, breathing, and circulation. If you are treating a severely injured patient, you may be too busy to begin or complete the detailed physical exam at all. This is not a failure on your part. Your responsibility is to give the patient the best care possible under the difficult conditions found in the field. If you do not do a complete assessment, but you keep a critical patient’s airway, breathing, and circulation intact, you have helped the patient far more than if you had done the complete assessment. Performing a detailed physical exam is always a lower priority than addressing life-threatening problems.

Performing the Detailed Physical Exam If you have not already exposed the patient, you need to do so now. Since you are now in the enclosed ambulance, it is much easier to protect the patient’s privacy and protect him from exposure to the environment. The detailed physical exam will look a lot like the rapid trauma assessment that you did during the secondary assessment. You will look for the familiar signs of wounds, tenderness and deformity.

Detailed Physical Exam in the Sequence of Assessment Priorities 1. Scene size-up. 2. Primary assessment and critical interventions for immediately lifethreatening problems. 3. History of the present illness, rapid physical exam, vital signs, plus interventions as needed. 4. Repeat primary assessment for immediately fifethreatening problems. Provide critical interventions as needed 5. Detailed physical exam (time and critical-care needs permitting). 6. Reassessment for life-threatening problems, plus reassessment of vital signs. Provide critical interventions as needed.

The detailed physical exam is similar to the rapid trauma assessment—with some important differences: • The exam usually takes place in the ambulance, en route. noise and motion may interfere with some procedures. • Since immobilization devices have been applied, you must work around them; for example, examining the ears through holes in the head immobilizer or below head tape, examining the neck through openings in the rigid collar, and examining only as much of the posterior as you can reach. There are only a few differences in the rest of the exam compared to what you did in the rapid trauma assessment. These differences result from cither the different environment (the back of the ambulance) or from the treatment you have already given to the patient (e.g.. cervical collar and immobilization on a backboard). When you assess the neck you will be limited by the cervical collar that you placed on the patient during the secondary assessment (rapid trauma assessment). You will not be able to inspect or palpate the back of the neck, but you will be able to assess for wounds, tenderness, deformities, jugular vein distention (JvD), and crepitation through the openings in the collar. You should make sure the collars you use have these openings. Remember that some degree of JvD may be a normal finding in a supine patient but is always an abnormal finding in a seated patient. LIFELINE

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Day 9 Reassessing the chest can be a challenge in a moving ambulance. You can reassess for anything you can palpate, such as crepitation or flail chest. However, because of road noise, breath sounds may be difficult to hear. Just keep in mind that you are auscultating for the presence and equality of breath sounds in your trauma patient, not the different kinds of abnormal sounds that are more common in medical patients. If you are unable to hear breath sounds because of road noise, it is generally better to continue transporting the patient to the hospital. It makes little sense to stop the ambulance and delay transport unless you can do something to treat an abnormality you find. Reassess the abdomen and pelvis as in the rapid assessment. Any deformities or other indications of a musculoskeletal injury to an extremity found during the rapid trauma assessment will most likely have been temporarily immobilized by securing the patient to the spine board. It is unlikely that taking lime to splint such injuries would have been appropriate at the scene when rapid transport was a priority. En route to the hospital, if the patient’s other injuries are not keeping you too busy, it may be a good time to apply a splint to an injured extremity after you perform the detailed physical exam. When it comes to reassessing the posterior body it would, of course, be inappropriate to roll the patient up off the backboard. By having the patient immobilized on a backboard, you are already treating for possible spine injury, so your primary concern at this point is to evaluate as much of the posterior body as you can reach for other injuries that may have been missed earlier, Simply reassess the flanks (sides) and as much of the spinal area as you can touch without moving the patient. Although the rest of the detailed physical exam is essentially the same as the rapid trauma assessment, you have more time, so you can be more thorough. This is especially true with long transports in rural or wilderness areas. Your next priority is to make sure that the emergency department is ready for your patient by using the ambulance radio or cellular phone to notify the emergency department of the patient’s condition. Depending on how far you are from the hospital and what your local protocols say. you may do this step before the detailed physical exam. If you have not yet notified the hospital, you should, do it now. 240

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REASSESSMENT Trauma Patient with No Significant Injury or Mechanism of Injury When caring for a trauma patient who is responsive and has no significant injury or mechanism of injury, you will have focused your assessment on just the areas the patient tells you hurt plus those areas that you suspect may be injured based on the mechanism of injury. This kind of patient received all the assessment he needed while still at the scene. He does not generally need a detailed physical exam. It is important to keep a high index of suspicion, though. When in doubt, do a detailed physical exam. Be aware of the responsive trauma patient’s fear and need for emotional support. You should perform a detailed physical exam on a trauma patient who has a significant injury (or mechanism of injury) and on any patient who has an unclear or unknown mechanism of injury. However, the detailed physical exam typically takes a different form in medical patients. This is because there are usually few signs an FMT can find in the physical exam of a medical patient that arc significant or about which you can or should do anything. Most of the assessment information on medical patients comes from the history and vital signs. Occasionally, you may come across a patient who could be either medical or trauma, or both. For example, imagine you have responded to an elderly man who is found alone and unconscious, slumped over the steering wheel of his car. The car is off the road and there is no damage to it. Did the patient lose consciousness first and then drive his car off the road, or did he drive off the road and then get knocked out from a blow to the head? The safest and best thing to do for a patient like this is generally to treat him as a trauma patient who gets a rapid trauma assessment and. if there is time, a detailed physical exam—but whenever possible, also get a history from any witnesses you can find.

Key Facts and Concepts • The patient without a significant mechanism or injury receives a history of the present illness and physical exam focused on areas that the patient complains about and areas that you think may be injured based on the mechanism of injury. • Next, gather a set of baseline vital signs and a past medical history. • For the patient with a significant injury or MOI. ensure continued manual stabilization of the head and neck, consider whether to call advanced life support personnel (if available), gel a brief history of the present illness, and then perform a rapid trauma assessment. • In the rapid trauma assessment, look for wounds, tenderness, and deformities, plus certain additional signs appropriate to the part being assessed. Systematically examine the head. neck, chest, abdomen, pelvis, extremities, and posterior body. • After assessing the neck, apply a

•

cervical collar. After completing the physical assessment, immobilize the patient to a spine board and get a baseline set of vital signs and a past medical history. After you have performed the appropriate critical interventions and begun transport, the patient may receive a detailed physical exam en route to the hospital The detailed physical exam is very similar to the rapid trauma assessment. hul there is time to be more thorough in the assessment. The detailed physical exam does not take place before transport unless transport is delayed. The detailed physical exam is most appropriate for the trauma patient who is unresponsive or has a significant injury or unknown MOl. A responsive trauma patient with no significant injury or MOI will seldom require a detailed physical exam.

REASSESSMENT LEARNING OBJECTIVES • Discuss the reasons for repeating the initial assessment as part of the ongoing assessment. • Describe the components and value of performing the ongoing assessment

It is important lo observe and re-observe your patient, not only to determine his condition when you first sec him. but also to detect any changes. The patient may exhibit an obvious change, like loss of consciousness, or more subtle differences, such as restlessness, anxiety, or sweating. These may indicate a change in circulation. Some patients may lake a turn for the worse before they reach the hospital, although this is uncommon. In some cases, you may see patient improvement, possibly in response to interventions you perform. You will perform reassessment on every patient after you have finished performing lifesaving interventions and, of ten, after you have done the detailed physical exam. Sometimes you may skip doing a detailed physical exam because you are too busy taking care of lifethreatening problems, or you have a medical or noncritical trauma patient for whom the detailed physical exam would not yield useful information. Reassessment, however, must never be skipped except when lifesaving interventions prevent you from doing it. Even in the latter situation, one partner can often perform the reassessment while the other continues lifesaving care. Throughout the assessment procedures that take place on the way lo the hospital, remember to explain to a conscious patient what you arc doing, talk in a reassuring tone, and consider the patient’s feelings, such as anxiety or embarrassment.

Ang tamang pagsusuri sa mismong lugar ng insidente at habang papunta sa ospital ay magbibigay sa iyo ng pagkakataon na makita at matugunan ang anumang injury o sakit na puwede mong makita. Hindi doon natatapos ang tungkulin mo. Puwedeng magbago ang lagay ng pasyente kaya importante na suriin siyang muli.

Components of Reassessment During the reassessment, you will repeat key elements of assessment procedures you have already performed. For example, you will repeat the primary assessment (to check for life-threatening problems), reassess vital signs, repeat the physical exam related lo the patient’s specific complaint or injuries, and check any interventions you have performed.

PEDIATRIC NOTE Remember to maintain eye contact with a conscious child, on the child’s level as much as possible, and explain what you ate doing in a quiet and reassuring voice.

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Repeat the Primary Assessment Begin reassessment by repeating the primary assessment to recheck for lifethreatening problems: • Reassess mental status. • Maintain an open airway. • Monitor breathing for rate and quality. • Reassess the pulse (or rate and quality. • Monitor skin color and temperature. • Re-establish patient priorities. Remember, life-threatening problems that were not present or were brought under control during the primary assessment may develop or redevelop before the patient reaches the hospital. For example, the mental status of the patient who was responsive and alert may begin to deteriorate, which is a significant trend and worrisome sign. The airway that was open may become occluded, the patient who was breathing adequately on his own may now require respiratory support, and other signs—such as a rapid pulse, cool skin, and pallor—may indicate the onset of shock. Life threats must be continually watched and managed immediately when discovered.

1. 2. 3. 4.

Reassessment

Repeat the primary assessment. Reassess and record vital signs. Repeat pertinent parts of the secondary assessment. Check interventions.

PEDIATRIC NOTE The mental status of an unresponsive child or infant can be checked by shouting (verbal stimulus) or flicking the feet (painful stimulus). Crying would be an expected response from a child with an adequate mental status

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Reassess and Record Vital Signs During the secondary assessment, you took and recorded a set of baseline vital signs: pulse, respiration, skin, pupils, and blood pressure. During reassessment, you will reassess and record the vital signs, comparing the results with the earlier baseline measurements and any other vital sign measurements you may have taken (for example, during the detailed physical exam, if you conducted one). Re -evaluate oxygen saturation if you previously assessed it. It is especially important to record each vital sign measurement as soon as you obtain it. In this way. you will not need to worry about remembering the different numbers you get for pulse rate, blood pressure, respiratory rate, and oxygen saturation. When you have more than one set of vital signs, it becomes even easier to forget them if you have not written them down. Another reason to document your reassessment is so that you can sec trends in the patient’s condition, which we will discuss later in this chapter.

Repeat Pertinent Parts of the History and Physical Exam A patient’s chief complaint may change over time, especially with regard to its severity. Ask the patient about changes in symptoms, especially ones that you anticipate because of treatments you have administered. At the same time, be careful not to suggest particular answers to the patient You may also find changes as you repeat the physical exam. For example, a chest injury may become apparent as muscles gel tired and you sec paradoxical motion that was not present or noticeable when you first assessed the patient (paradoxical motion is present when a part of the chest goes in as the patient inhales and goes out as the patient exhales, opposite to the motion of the rest of the chest). The abdomen may become distended, a sign that you are especially likely to see if you have a long transport. As you learn more about specific injuries and illnesses in later chapters, you w ill learn more signs to look for in your reassessment.

Check Interventions Whenever you check the interventions that you have performed for a patient, try to take a fresh look at the patient. Attempt to see the patient as though you had never seen him before. This may help you to evaluate the adequacy of your interventions more objectively and to adjust them as necessary. Always do the following: • Ensure adequacy of oxygen delivery and artificial ventilation. • Ensure management of bleeding. • Ensure adequacy of other interventions. Situations change. The fact that you put the patient on oxygen initially does not prevent the tank from running out later, or the tubing from becoming kinked or disconnected. A good habit to develop is to check the entire path of the oxygen from the tank to the patient. This means looking at the regulator on the lank and confirming that it has sufficient oxygen and that the flow meter is set to the proper flow. Make sure that the tube is firmly connected to the regulator. Follow the tubing and make sure there are no kinks that would prevent the flow of oxygen. Look at the mask. Make sure the tubing is connected to it. and that it is the proper mask. Confirm that it is snug on the patient’s face and, if it is a nonrebreather mask, that the nonrebreather bag does not completely deflate when the patient inhales. Increase the flow rate if it does. With practice, this sequence of steps will take just a few seconds. Wounds that stopped bleeding can start bleeding again, so it is important to check them as part of reassessment. Check any bandage you have applied and make sure it is dry with no blood seeping through. When an unbandaged wound is in a location where you cannot see it, gently palpate it with gloved hands and check your gloves for blood. Also be sure to check other interventions, such as cervical collars, backboard straps, and splints. Any of these can slip and need adjustment.

Observing Trends Because reassessment is a means of determining trending (changes over time) in the patient’s condition, you will need to repeat the reassessment steps frequently. Be sure to record your findings and compare them to earlier findings. It is important to notice and document any changes or trends.

Trending Vital Signs Observing a trend in vital signs- treading—is more valuable than getting an individual set of vital signs. Observing trends is essential for making accurate decisions regarding transport destination and whether ALS may be necessary. In rural EMS, long transport distances and times may dictate many reassessments— at least every 15 minutes for a stable patient, at least every 5 minutes for an unstable patient. Based on your findings, you may need to institute new treatment or adjust treatments you have already started. Your findings, in particular any trends you have noted, will also be important information for the hospital staff and will let them know if the patient’s conditions is improving or deteriorating.

Reassessment for Stable and Unstable Patients The patient’s condition, as well as the length of lime you spend with the patient, will determine just how often you will conduct the reassessment. The more serious the patient’s condition, the more often you will do it. unless your protocols direct you to do otherwise, reassess your patient at these intervals: • Every 15 minutes for a stable patient, such as a patient who is alert, has vital signs in the normal range, and has no serious injury. • Every 5 minutes for an unstable or potentially unstable patient, such as a patient who has an altered mental status; difficulty with airway, breathing, or circulation. Including severe blood loss; or a significant mechanism of injury. Whenever you believe there may have been a change in the patient’s condition, repeat at least the primary assessment. In this way. you will detect signs of lifethreatening conditions as soon as possible. When in doubt, repeat reassessment every 5 minutes or as frequently as possible.

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